1003279407 NPI number — COMPLETE PHYSICAL THERAPY, LLC

Table of content: DR. MATTHEW J. DENEAU DPT (NPI 1841735453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003279407 NPI number — COMPLETE PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003279407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2948 HOGAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-6078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-258-9426
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2948 HOGAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-6078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-258-9426
Provider Business Practice Location Address Fax Number:
307-224-6463
Provider Enumeration Date:
04/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FRONTIERO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
307-259-7079

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT-1212 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21514 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1558553339 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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