Provider Demographics
NPI:1376943696
Name:POMEROY, ROGER
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:POMEROY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-0790
Mailing Address - Country:US
Mailing Address - Phone:307-864-2146
Mailing Address - Fax:307-864-2857
Practice Address - Street 1:148 E ARAPAHOE ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2402
Practice Address - Country:US
Practice Address - Phone:307-864-2146
Practice Address - Fax:307-864-2857
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist