Provider Demographics
NPI:1679702518
Name:SVEJCAR, MICHAEL ROSS (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROSS
Last Name:SVEJCAR
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-1497
Mailing Address - Country:US
Mailing Address - Phone:307-875-8492
Mailing Address - Fax:307-875-7389
Practice Address - Street 1:140 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935
Practice Address - Country:US
Practice Address - Phone:307-875-8492
Practice Address - Fax:307-875-8492
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT 1099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307402Medicare Oscar/Certification