Organization
JACKSON HOLE PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA HARMON (ADMINISTRATOR)
(307) 734-5292
Entity
Organization
Contact information
Practice address
4030 LAKE CREEK DR N, WILSON, WY 83014-9689
(307) 734-5292
(307) 734-8834
Mailing address
PO BOX 1828, JACKSON, WY 83001-1828
(307) 734-5292
(307) 734-8834
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05915001
BLUE CROSS OF WY
WY
Enumeration date
10/24/2006
Last updated
11/27/2007
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