=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518603281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WYPT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2022
-----------------------------------------------------
Last Update Date | 06/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 W MAIN ST
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82701-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-746-2200
-----------------------------------------------------
Fax | 307-746-2216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 W MAIN ST
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82701-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-746-2200
-----------------------------------------------------
Fax | 307-746-2216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, DPT, PT
-----------------------------------------------------
Name | BRANDY JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-746-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------