Provider Demographics
NPI:1619963014
Name:HERKSTROETER, LUANN S (PT)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:S
Last Name:HERKSTROETER
Suffix:
Gender:F
Credentials:PT
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 1146
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1146
Mailing Address - Country:US
Mailing Address - Phone:307-745-5434
Mailing Address - Fax:307-745-5484
Practice Address - Street 1:1575 N 4TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2091
Practice Address - Country:US
Practice Address - Phone:307-745-5434
Practice Address - Fax:307-745-5484
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312638OtherBLUE CROSS BLUE SHIELD
WYP00199469OtherRAILROAD MEDICARE
WY312638OtherBLUE CROSS BLUE SHIELD