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General NPI Number Information
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NPI Number | 1487269569
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Entity Type | Organization
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Legal Business Name | ALLRED PERFORMANCE AND REHABILITATION LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 533 ALLRED RD
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City | AFTON
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State | WY
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Zip | 83110
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Country | US
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Telephone | 307-877-6206
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Fax |
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Provider Business Mailing Address
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Address Line | 533 ALLRED RD
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City | AFTON
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State | WY
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Zip | 83110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN ALLRED
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Credential |
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Telephone | 307-887-6206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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