WYOMING SPECIALIZED PHYSICAL THERAPY (NPI# 1336151265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336151265 |
| Entity Type | Organization |
| Organization Name | WYOMING SPECIALIZED PHYSICAL THERAPY |
| Practice Address |
620 West Cheyenne Dr. Evanston WY 82930-5359 |
| Practice Telephone | 3077898860 |
| Practice Fax Number | 3077898394 |
| Mailing Telephone | 3077898860 |
| Mailing Fax Number | 3077898394 |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHAEL GENE JACKETTA (OWNER PHYSICAL THERAPIST) |
| Authorized Official Telephone | 3077898860 |
| Authorized Official Credential | MPT, OCS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
620 WEST CHEYENNE DR. |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-5359 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366883019 | Colleen Elizabeth Mcgraw | Physical Therapist | 1000 Central St Ste 101, Evanston, IL 60201-1780 | 2013-07-10 |
| 1023336823 | Teresa Maciejczyk | Physical Therapist | 1729 Benson Ave, Evanston, IL 60201-3704 | 2010-05-04 |
| 1548585433 | Jason Patrick Sweas | Physical Therapist | 1729 Benson Ave, Evanston, IL 60201-3704 | 2010-04-02 |
| 1740505239 | Amy Terpstra | Physical Therapist | 1729 Benson Ave, Evanston, IL 60201-3704 | 2010-03-29 |
| 1851615504 | Rebecca Anne Paulin-liston | Physical Therapist | 1729 Benson Ave, Evanston, IL 60201-3704 | 2010-03-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073120358 | Forge Physio and Performance LLC | Physical Therapist | 1095 Broadway St, Sheridan, WY 82801-3054 | 2020-09-30 |
| 1578121588 | Nina Clark Lex | Physical Therapist | 1230 N Fall Creek Rd, Wilson, WY 83014 | 2019-06-04 |
| 1043878408 | Cossette Burnham | Physical Therapist | Four Pines Physical Therapy, 1090 S Hwy 89, Jackson, WY 83001 | 2019-05-31 |
| 1386000727 | Taylor Lindsey | Physical Therapist | 1090 S Us Hwy 89, Jackson, WY 83001 | 2016-01-14 |
| 1144579731 | Move On Physical Therapy, Inc. | Physical Therapist | 1201 E. 7th Street, Powell, WY 82435 | 2012-08-29 |
| 1588744049 | Celeste Scheer | Physical Therapist | 800 E 20th St Ste 300, Cheyenne, WY 82001-3882 | 2006-10-17 |
| 1538274113 | Daniel E Fox | Physical Therapist | 4028 Laramie St, Cheyenne, WY 82001-2064 | 2006-08-21 |
| 1386286433 | Andrea Williams | Physical Therapist | 214 E 23rd St, Cheyenne, WY 82001-3748 | 2019-10-10 |
| 1689145484 | Kyle Graves | Physical Therapist | 1211 S Douglas Hwy Ste 100, Gillette, WY 82716-4982 | 2018-12-06 |
| 1639658990 | George Douglas Hayden IIi | Physical Therapist | 555 E Broadway Ave # 100, Jackson, WY 83001-8640 | 2018-08-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.