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General NPI Number Information
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NPI Number | 1306708557
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Entity Type | Organization
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Legal Business Name | BLACK TOOTH PHYSIOTHERAPY AND PERFORMANCE, LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 682 N MAIN ST STE 3
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City | BUFFALO
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State | WY
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Zip | 82834-1736
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Country | US
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Telephone | 307-620-5712
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Fax |
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Provider Business Mailing Address
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Address Line | 682 N MAIN ST STE 3
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City | BUFFALO
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State | WY
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Zip | 82834-1736
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Country | US
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Telephone | 307-620-5712
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. MATTHEW JAMES SCARLETT
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Credential | MS, PT, DPT
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Telephone | 307-620-5712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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