Provider Demographics
NPI:1366853418
Name:GIDDY UP WELLNESS & THERAPY SERVICES
Entity Type:Organization
Organization Name:GIDDY UP WELLNESS & THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OCCUPATIONAL THE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT OT
Authorized Official - Phone:307-461-9891
Mailing Address - Street 1:1949 SUGARLAND DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5755
Mailing Address - Country:US
Mailing Address - Phone:307-461-9891
Mailing Address - Fax:307-939-7097
Practice Address - Street 1:1949 SUGARLAND DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-461-9891
Practice Address - Fax:307-939-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1358261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy