Provider Demographics
NPI:1497791065
Name:WHITCOMB, TRISHA BRYN (MPT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:BRYN
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 E 2ND ST
Mailing Address - Street 2:#500
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2047
Mailing Address - Country:US
Mailing Address - Phone:307-577-5204
Mailing Address - Fax:307-577-5212
Practice Address - Street 1:2546 E 2ND ST
Practice Address - Street 2:#500
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2047
Practice Address - Country:US
Practice Address - Phone:307-577-5204
Practice Address - Fax:307-577-5212
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312179OtherBLUE CROSS BLUE SHIELD WY
WY118493800Medicaid