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General NPI Number Information
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NPI Number | 1710172796
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Entity Type | Organization
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Legal Business Name | SKY PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 970 W BROADWAY
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City | JACKSON
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State | WY
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Zip | 83001-9475
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Country | US
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Telephone | 307-733-7173
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9163
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City | JACKSON
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State | WY
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Zip | 83002-9163
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Country | US
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Telephone | 307-733-7173
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN VAN HATTEN
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Credential | PT, OCS
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Telephone | 307-733-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 325
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License Number State | WY
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