Organization
PEDRICK INC
Active
Other names
High Country Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REED PEDRICK (OWNER ADMINISTRATOR)
(307) 742-3110
Entity
Organization
Contact information
Practice address
3125 E GRAND AVE, SUITE A, LARAMIE, WY 82070-5137
(307) 742-3110
Mailing address
3125 E GRAND AVE, SUITE A, LARAMIE, WY 82070-5137
(307) 742-3110
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 036
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1068407 00
—
WY
Enumeration date
11/21/2006
Last updated
03/30/2011
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