Provider Demographics
NPI:1972268431
Name:DAVIS OUTPATIENT THERAPY LLC
Entity Type:Organization
Organization Name:DAVIS OUTPATIENT THERAPY LLC
Other - Org Name:HEALING HEARTS HOME HEALTH OUTPATIENT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACY
Authorized Official - Middle Name:LARAE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-756-9200
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:MOORCROFT
Mailing Address - State:WY
Mailing Address - Zip Code:82721-0338
Mailing Address - Country:US
Mailing Address - Phone:307-756-9200
Mailing Address - Fax:888-715-6736
Practice Address - Street 1:902 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4023
Practice Address - Country:US
Practice Address - Phone:307-756-9200
Practice Address - Fax:888-715-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty