Provider Demographics
NPI:1710317797
Name:ANDERSON, JALYN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 BARRATT ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5431
Mailing Address - Country:US
Mailing Address - Phone:307-761-3110
Mailing Address - Fax:307-426-4148
Practice Address - Street 1:3905 E GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5189
Practice Address - Country:US
Practice Address - Phone:307-742-2082
Practice Address - Fax:307-426-4148
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-13392251G0304X, 2251N0400X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic