Provider Demographics
NPI:1164469995
Name:PARRIS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PARRIS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:307-638-0300
Mailing Address - Street 1:PO BOX 20188
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7004
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:4202 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1744
Practice Address - Country:US
Practice Address - Phone:307-638-0300
Practice Address - Fax:307-638-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT843208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313961OtherBLUE CROSS BLUE SHIELD
WYS87492Medicare UPIN
WYP00271401Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WY313961OtherBLUE CROSS BLUE SHIELD