Provider Demographics
NPI:1982634879
Name:JIM WHEELER PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:JIM WHEELER PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:PHYSCIAL THERAPY OF STAR VALLEY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JESKE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:307-883-7878
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127-0932
Mailing Address - Country:US
Mailing Address - Phone:307-883-7878
Mailing Address - Fax:307-883-7877
Practice Address - Street 1:124 PETERSEN PARKWAY
Practice Address - Street 2:
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127-0954
Practice Address - Country:US
Practice Address - Phone:307-883-7878
Practice Address - Fax:307-883-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW20625Medicare ID - Type UnspecifiedGROUP MEDICARE #