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General NPI Number Information
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NPI Number | 1558742981
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Entity Type | Organization
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Legal Business Name | BACK COUNTRY PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1262 W 5TH ST
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City | SHERIDAN
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State | WY
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Zip | 82801-2702
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Country | US
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Telephone | 307-336-7774
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Fax | 307-202-4643
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Provider Business Mailing Address
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Address Line | 51 COFFEEN AVE. STE 101 PMB 286
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City | SHERIDAN
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State | WY
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Zip | 82801-7004
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Country | US
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Telephone | 307-336-7774
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Fax | 307-202-4643
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. BRETT A JENKS
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Credential | PT, DPT, CERT. MDT
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Telephone | 307-336-7774
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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 | PT-1552
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License Number State | WY
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