Provider Demographics
NPI:1144109646
Name:TETON ADVANCED THERAPIES P.C.
Entity type:Organization
Organization Name:TETON ADVANCED THERAPIES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:ROLLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-869-2900
Mailing Address - Street 1:4095 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2422
Mailing Address - Country:US
Mailing Address - Phone:310-869-2900
Mailing Address - Fax:
Practice Address - Street 1:630 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2613
Practice Address - Country:US
Practice Address - Phone:310-869-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty