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NPI Code Detail

MEDICARE: LITTLE GOOSE THERAPY LLC

MEDICARE: LITTLE GOOSE THERAPY 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
1225X00000XOccupational Therapist
2225100000XPhysical Therapist
3261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1609229319
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE GOOSE THERAPY LLC
Provider Business Mailing Address
First Line : 345 S LINDEN AVE
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-4709
Country : US
Telephone Number : 307-683-0123
Fax Number : 307-683-0101
Provider Business Practice Location Address
First Line : 345 S LINDEN AVE
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-4709
Country : US
Telephone Number : 307-683-0123
Fax Number : 307-683-0101
Authorized Official
Title or Position : PT, OWNER
Name : BRIAN C ALLRED
Credential :
Telephone Number : 307-683-0123
Provider Enumeration Date : 07/18/2016
Last Update Date : 04/09/2026

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Directions to “LITTLE GOOSE THERAPY LLC ” Practice Location

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