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General NPI Number Information
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NPI Number | 1619963014
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Entity Type | Individual
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Provider Name | LUANN S HERKSTROETER P.T.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 1575 N 4TH ST SUITE 101
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City | LARAMIE
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State | WY
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Zip | 82072-2091
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Country | US
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Telephone | 307-745-5434
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Fax | 307-745-5484
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Provider Business Mailing Address
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Address Line | PO BOX 1146
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City | LARAMIE
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State | WY
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Zip | 82073-1146
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Country | US
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Telephone | 307-745-5434
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Fax | 307-745-5484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 362
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License Number State | WY
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