MEDICARE: 307 DIAGNOSTIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1235084328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	307 DIAGNOSTIC CENTER

Provider Business Mailing Address
First Line	:	137 E 13TH ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-4230
Country	:	US
Telephone Number	:	307-439-6465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 CENTENNIAL CT
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-7304
Country	:	US
Telephone Number	:	307-439-6465
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHY BLAIR
Credential	:	DPT
Telephone Number	:	307-235-3910

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “307 DIAGNOSTIC CENTER ” Practice Location

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