Organization
GILLETTE PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH L CLOUSTON DPT (PARTNER)
(307) 682-4900
Entity
Organization
Contact information
Practice address
1013 EAST BOXELDER, GILLETTE, WY 82718-5536
(307) 682-4900
(307) 687-7243
Mailing address
PO BOX 7132, GILLETTE, WY 82717-7132
(307) 682-4900
(307) 687-7243
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120766100
—
WY
Enumeration date
05/04/2006
Last updated
03/15/2018
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