Provider Demographics
NPI:1548677701
Name:WIND RIVER PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WIND RIVER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:307-335-5188
Mailing Address - Street 1:364 NORTH 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3033
Mailing Address - Country:US
Mailing Address - Phone:307-335-5188
Mailing Address - Fax:307-333-0600
Practice Address - Street 1:150 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2846
Practice Address - Country:US
Practice Address - Phone:307-335-5188
Practice Address - Fax:307-333-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY-1202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty