Individual
THOMAS DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
2002 W SUNSET DR, SUITE 1, RIVERTON, WY 82501-2283
(307) 856-7021
(307) 856-5546
Mailing address
8168 HIGHWAY 789, LANDER, WY 82520-2953
(307) 332-5240
(307) 332-5241
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1538
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477568046
BLUE CROSS BLUE SHIELD OF WYOMING
WY
05
—
1477568046
—
WY
Enumeration date
08/04/2014
Last updated
08/04/2014
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