Healthcare Provider Details

I. General information

NPI: 1508883471
Provider Name (Legal Business Name): NORTH PLATTE PHYSICAL THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W MAIN ST
NEWCASTLE WY
82701-2719
US

IV. Provider business mailing address

PO BOX 1790
DOUGLAS WY
82633-1790
US

V. Phone/Fax

Practice location:
  • Phone: 370-746-3573
  • Fax:
Mailing address:
  • Phone: 307-358-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISA MANGUS
Title or Position: CFO
Credential:
Phone: 307-358-9464