Organization
BIG COUNTRY REHABILITATION,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MANGUS (CFO)
(307) 358-9464
Entity
Organization
Contact information
Practice address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-9464
Mailing address
PO BOX 1790, DOUGLAS, WY 82633-1790
(307) 358-9464
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117140201
—
WY
Enumeration date
05/15/2006
Last updated
11/10/2015
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