Organization
SPORTS AND REHABILITATION CENTER OF WYOMING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIN HAMMESFAHR (MANAGER)
(310) 307-9670
Entity
Organization
Contact information
Practice address
625 E BROADWAY AVE, JACKSON, WY 83001-8642
(307) 920-1688
Mailing address
522 N SWEETZER AVE APT 5, LOS ANGELES, CA 90048-2659
(310) 307-9670
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
12/22/2020
Last updated
05/23/2021
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