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Organization

ROCKY MOUNTAIN SPORTS MEDICINE AND REHABILITATION LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JAELYN ANN KNUDSON (OFFICE ADMINISTRATOR)
(307) 352-3626
Entity
Organization

Contact information

Practice address
1401 GATEWAY BLVD STE 2, ROCK SPRINGS, WY 82901-6786
(307) 352-3626
(307) 352-3628
Mailing address
1401 GATEWAY BLVD UNIT 2, ROCK SPRINGS, WY 82901-6727
(307) 352-3626
(307) 352-3628

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
225X00000X
Occupational Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
118547100
WY
Enumeration date
08/16/2006
Last updated
07/06/2011
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