Organization
PHYSIO 2 SPORT L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARYN KILTY D.P.T. (OWNER)
(307) 630-0740
Entity
Organization
Contact information
Practice address
560 2ND AVENUE, SUITE 217, LAGRANGE, WY 82221
(307) 630-0740
Mailing address
PO BOX 88, LAGRANGE, WY 82221
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1404
WY
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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