1699968404 NPI number — HOMESTEAD PHYSICAL THERAPY PC

Table of content: APOLONIO CACHOLA CANARIA JR. M.D. (NPI 1790882421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699968404 NPI number — HOMESTEAD PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMESTEAD PHYSICAL THERAPY PC
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:
1699968404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARAMIE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82073-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-745-5434
Provider Business Mailing Address Fax Number:
307-745-5484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1575 N 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82072-2091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-745-5434
Provider Business Practice Location Address Fax Number:
307-745-5484
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERKSTROETER
Authorized Official First Name:
LUANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
307-745-5434

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DC9388 . This is a "MEDICARE RAILROAD CARRIER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 01248/001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com