| NPI | 1003257601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L MAZUR Owner 307-335-3471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2025-04-07 |