Provider Demographics
NPI:1275185944
Name:WYOMING PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:WYOMING PHYSICAL THERAPY PC
Other - Org Name:BROOKSIDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-223-6177
Mailing Address - Street 1:1217 S GREELEY HWY STE A
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3063
Mailing Address - Country:US
Mailing Address - Phone:307-772-0955
Mailing Address - Fax:307-772-0953
Practice Address - Street 1:322 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:PINE BLUFFS
Practice Address - State:WY
Practice Address - Zip Code:82082
Practice Address - Country:US
Practice Address - Phone:307-245-3858
Practice Address - Fax:307-245-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty