Organization
SPORTS AND REHABILITATION CENTER OF WYOMING LLC
Active
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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