Provider Demographics
NPI:1275606428
Name:REED, MICHAEL CLARK (MSPT, CWS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLARK
Last Name:REED
Suffix:
Gender:M
Credentials:MSPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2613
Mailing Address - Country:US
Mailing Address - Phone:307-266-4600
Mailing Address - Fax:
Practice Address - Street 1:630 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2613
Practice Address - Country:US
Practice Address - Phone:307-266-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9676OtherPROVIDER NUMBER