Healthcare Provider Details

I. General information

NPI: 1982634879
Provider Name (Legal Business Name): JIM WHEELER PHYSICAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PETERSEN PARKWAY
THAYNE WY
83127-0954
US

IV. Provider business mailing address

PO BOX 932
THAYNE WY
83127-0932
US

V. Phone/Fax

Practice location:
  • Phone: 307-883-7878
  • Fax: 307-883-7877
Mailing address:
  • Phone: 307-883-7878
  • Fax: 307-883-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT948
License Number StateWY

VIII. Authorized Official

Name: MR. DANIEL DEAN JESKE
Title or Position: OWNER PHYSICAL THERAPIST
Credential: MPT
Phone: 307-883-7878