Healthcare Provider Details

I. General information

NPI: 1275564122
Provider Name (Legal Business Name): TETON THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W MAIN ST
RIVERTON WY
82501-3239
US

IV. Provider business mailing address

1406 W MAIN ST
RIVERTON WY
82501-3239
US

V. Phone/Fax

Practice location:
  • Phone: 307-857-7074
  • Fax: 307-856-6459
Mailing address:
  • Phone: 307-463-0462
  • Fax: 307-463-2010

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: JENNIFER HEGWOOD
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 307-463-0462