Provider Demographics
NPI:1942470737
Name:WYOMING PHYSIATRY INC
Entity Type:Organization
Organization Name:WYOMING PHYSIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-265-7731
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:5715 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4322
Practice Address - Country:US
Practice Address - Phone:307-268-7731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6809A225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21781OtherGROUP MEDICARE
WY126432000OtherGROUP MEDICAID
WY118696500Medicaid
WY126432000OtherGROUP MEDICAID