Organization
HOMESTEAD PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUANN HERKSTROETER P.T. (OWNER/PRESIDENT)
(307) 745-5434
Entity
Organization
Contact information
Practice address
1575 N 4TH ST, SUITE 101, LARAMIE, WY 82072-2091
(307) 745-5434
(307) 745-5484
Mailing address
PO BOX 1146, LARAMIE, WY 82073-1146
(307) 745-5434
(307) 745-5484
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01248/001
BLUE CROSS BLUE SHIELD
WY
01
—
DC9388
MEDICARE RAILROAD CARRIER
WY
Enumeration date
08/24/2007
Last updated
11/27/2007
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