MEDICARE: MOUNTAIN PHYSIO LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1386245298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN PHYSIO LLC

Provider Business Mailing Address
First Line	:	PO BOX 10304
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-0304
Country	:	US
Telephone Number	:	207-491-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 ASPEN DR UNIT 2
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8611
Country	:	US
Telephone Number	:	207-491-8989
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ALEXANDRA A DRECHSEL
Credential	:	DPT
Telephone Number	:	207-491-8989

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

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Directions to “MOUNTAIN PHYSIO LLC ” Practice Location

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