Healthcare Provider Details

I. General information

NPI: 1447349626
Provider Name (Legal Business Name): JEANNA LAJOIEU GROSCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 15TH ST
WORLAND WY
82401-3531
US

IV. Provider business mailing address

PO BOX 897
WORLAND WY
82401-0897
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-6952
  • Fax: 307-347-6962
Mailing address:
  • Phone: 307-347-3848
  • Fax: 307-347-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number318
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: