Provider Demographics
NPI:1497832141
Name:BRYNGELSON, JOSETTE L (MPT)
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:L
Last Name:BRYNGELSON
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 1:416 W BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-7113
Mailing Address - Country:US
Mailing Address - Phone:307-352-3626
Mailing Address - Fax:307-352-3628
Practice Address - Street 1:416 W BLAIR AVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-7113
Practice Address - Country:US
Practice Address - Phone:307-352-3626
Practice Address - Fax:307-352-3628
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist