Provider Demographics
NPI:1144606245
Name:HUGHES, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21359
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7026
Mailing Address - Country:US
Mailing Address - Phone:307-421-9728
Mailing Address - Fax:
Practice Address - Street 1:1409 HARVEST WAY
Practice Address - Street 2:BOX 21359
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82003
Practice Address - Country:US
Practice Address - Phone:307-421-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0857225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant