Provider Demographics
NPI:1609229319
Name:LITTLE GOOSE THERAPY LLC
Entity Type:Organization
Organization Name:LITTLE GOOSE THERAPY LLC
Other - Org Name:ADVANCE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-683-0123
Mailing Address - Street 1:727 E BRUNDAGE LN STE L
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6280
Mailing Address - Country:US
Mailing Address - Phone:307-683-0123
Mailing Address - Fax:307-683-0101
Practice Address - Street 1:727 E BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6274
Practice Address - Country:US
Practice Address - Phone:307-683-0123
Practice Address - Fax:307-683-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty