Healthcare Provider Details

I. General information

NPI: 1619963014
Provider Name (Legal Business Name): LUANN S HERKSTROETER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N 4TH ST SUITE 101
LARAMIE WY
82072-2091
US

IV. Provider business mailing address

PO BOX 1146
LARAMIE WY
82073-1146
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-5434
  • Fax: 307-745-5484
Mailing address:
  • Phone: 307-745-5434
  • Fax: 307-745-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number362
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: