Provider Demographics
NPI:1265493902
Name:ROCKY MOUNTAIN THERAPY LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN THERAPY LLC
Other - Org Name:ROCKY MOUNTAIN THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:307-577-5204
Mailing Address - Street 1:2546 E 2ND ST
Mailing Address - Street 2:BUILDING 500
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2047
Mailing Address - Country:US
Mailing Address - Phone:307-577-5204
Mailing Address - Fax:307-577-5212
Practice Address - Street 1:2546 E 2ND ST
Practice Address - Street 2:BUILDING 500
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2047
Practice Address - Country:US
Practice Address - Phone:307-577-5204
Practice Address - Fax:307-577-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCOTA-621224Z00000X
WYCOTA-534224Z00000X
WYCOTA-589224Z00000X
WYCOTA-617224Z00000X
WYPT-891225100000X
WYPTA-331225200000X
WYPTA-537225200000X
WYOTR-452225X00000X
WYOTR-031225XH1200X
WYSP-169235Z00000X
WYSP-395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3120039OtherWY WORKERS COMP BA #
WY00693001OtherBCBS OF WYOMING
WY118492000Medicaid
WY3120039OtherWY WORKERS COMP BA #