| NPI | 1336151265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL G JACKETTA Owner 307-789-8860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-11-01 |