Organization
OPTIMAL AQUA THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JORDAN WASHBURN MD, MPH (DIRECTOR)
(307) 514-0510
Entity
Organization
Contact information
Practice address
611 E CARLSON ST STE 117D, CHEYENNE, WY 82009-4311
(307) 514-0510
(307) 514-2941
Mailing address
611 E CARLSON ST STE 117D, CHEYENNE, WY 82009-4311
(307) 514-0510
(307) 514-2941
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/08/2020
Last updated
05/08/2020
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