Provider Demographics
NPI:1275747628
Name:TETON HAND THERAPY LLC
Entity Type:Organization
Organization Name:TETON HAND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:307-734-2877
Mailing Address - Street 1:PO BOX 4596
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4596
Mailing Address - Country:US
Mailing Address - Phone:307-734-2877
Mailing Address - Fax:307-734-2827
Practice Address - Street 1:310 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-0000
Practice Address - Country:US
Practice Address - Phone:307-734-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT059332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122059400Medicaid
WY785001OtherBLUE SHIELD GROUP
WY785001OtherBLUE SHIELD GROUP
WY122059400Medicaid