Individual
DIANE JANICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.P.T
Contact information
Practice address
140 COMMERCE DR, GREEN RIVER, WY 82935-6178
(307) 875-8492
(307) 875-7389
Mailing address
PO BOX 1497, GREEN RIVER, WY 82935-1497
(307) 875-8492
(307) 875-7389
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
218
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110936700
—
WY
Enumeration date
06/25/2008
Last updated
06/25/2008
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