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General NPI Number Information
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NPI Number | 1366853418
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Entity Type | Organization
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Legal Business Name | GIDDY UP WELLNESS & THERAPY SERVICES
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 06/06/2020
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Provider Practice Location Address
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Address Line | 1949 SUGARLAND DRIVE SUITE 200
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City | SHERIDAN
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State | WY
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Zip | 82801-5755
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Country | US
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Telephone | 307-461-9891
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Fax | 307-939-7097
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Provider Business Mailing Address
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Address Line | 1949 SUGARLAND DRIVE SUITE 200
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City | SHERIDAN
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State | WY
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Zip | 82801-5755
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Country | US
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Telephone | 307-461-9891
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Fax | 307-939-7097
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OCCUPATIONAL THE
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Name | MRS. MICHELLE GILMER
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Credential | PT OT
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Telephone | 307-461-9891
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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 | 1358
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License Number State | WY
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