Healthcare Provider Details

I. General information

NPI: 1699968404
Provider Name (Legal Business Name): HOMESTEAD PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 11/27/2007
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUANN HERKSTROETER
Title or Position: OWNER/PRESIDENT
Credential: P.T.
Phone: 307-745-5434