1952484511 NPI number — JACKSON HOLE PHYSICAL THERAPY, PC

Table of content: (NPI 1952484511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952484511 NPI number — JACKSON HOLE PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON HOLE 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:
1952484511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1828
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83001-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-734-5292
Provider Business Mailing Address Fax Number:
307-734-8834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 SCOTT LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-734-9005
Provider Business Practice Location Address Fax Number:
307-734-4424
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARMON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
307-734-9005

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05915001 . This is a "BLUE CROSS OF WY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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