1922549484 NPI number — PATHFINDER PHYSICAL THERAPY, LLC

Table of content: (NPI 1922549484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922549484 NPI number — PATHFINDER PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHFINDER 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:
1922549484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 LANDMARK DR
Provider Second Line Business Mailing Address:
STE 230
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82609-4562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-337-3200
Provider Business Mailing Address Fax Number:
307-448-3046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 LANDMARK DR
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82609-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-337-3200
Provider Business Practice Location Address Fax Number:
307-448-3046
Provider Enumeration Date:
03/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER, COO, PHYSICAL THERAPIST
Authorized Official Telephone Number:
307-337-3200

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1241 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 916 , 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)





Copyright © 2007-2025 www.npivalidator.com