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General NPI Number Information
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NPI Number | 1548677701
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Entity Type | Organization
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Legal Business Name | WIND RIVER PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 150 LINCOLN ST
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City | LANDER
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State | WY
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Zip | 82520-2846
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Country | US
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Telephone | 307-335-5188
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Fax | 307-333-0600
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Provider Business Mailing Address
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Address Line | 364 NORTH 2ND STREET
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City | LANDER
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State | WY
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Zip | 82520-3033
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Country | US
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Telephone | 307-335-5188
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Fax | 307-333-0600
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Authorized Official
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Title or Position | OWNER
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Name | TY NATHANIEL FRANCIS
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Credential | MPT
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Telephone | 307-335-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | WY-1202
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License Number State | WY
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