| NPI | 1508979535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAELYN ANN KNUDSON Office Administrator 307-352-3626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2011-07-06 |