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General NPI Number Information
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NPI Number | 1609229319
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Entity Type | Organization
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Legal Business Name | LITTLE GOOSE THERAPY LLC
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 727 E BRUNDAGE LN
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City | SHERIDAN
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State | WY
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Zip | 82801-6274
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Country | US
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Telephone | 307-683-0123
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Fax | 307-683-0101
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Provider Business Mailing Address
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Address Line | 727 E BRUNDAGE LN STE L
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City | SHERIDAN
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State | WY
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Zip | 82801-6280
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Country | US
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Telephone | 307-683-0123
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Fax | 307-683-0101
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SANJA WEART
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Credential |
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Telephone | 307-683-0123
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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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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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