Individual
JODY FAXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6631 E 2ND ST, CASPER, WY 82609-4355
(307) 268-9904
(307) 268-9907
Mailing address
6631 E 2ND ST, CASPER, WY 82609-4355
(307) 268-9904
(307) 268-9907
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0305
WY
Other
Enumeration date
09/22/2011
Last updated
09/22/2011
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