Organization
FREMONT THERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT E PHISTER MPT (OWNER)
(307) 856-7021
Entity
Organization
Contact information
Practice address
2002 WEST SUNSET DRIVE, SUITE 1, RIVERTON, WY 82501
(307) 856-7021
(307) 856-5546
Mailing address
2002 WEST SUNSET DRIVE, SUITE 1, RIVERTON, WY 82501
(307) 856-7021
(307) 856-5546
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111952400
—
WY
01
—
1524243
UNITED MINEWORKERS
—
01
—
185794800
ACS DEPT OF LABOR
—
01
—
303969
BLUE CROSS BLUE SHIELD
WY
01
—
C65268
RAILROAD MEDICARE
—
Enumeration date
07/30/2006
Last updated
10/08/2010
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