Healthcare Provider Details

I. General information

NPI: 1346571882
Provider Name (Legal Business Name): JAMES ERIC KLAASSEN MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RENO DRIVE UNIT B
WRIGHT WY
82732
US

IV. Provider business mailing address

4300 SPRING HILL RD
GILLETTE WY
82718-8508
US

V. Phone/Fax

Practice location:
  • Phone: 307-359-1588
  • Fax: 307-464-5726
Mailing address:
  • Phone: 307-359-1588
  • Fax: 307-464-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT-0844
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: