Provider Demographics
NPI:1003279407
Name:COMPLETE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONTIERO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:307-259-7079
Mailing Address - Street 1:2948 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6078
Mailing Address - Country:US
Mailing Address - Phone:307-258-9426
Mailing Address - Fax:
Practice Address - Street 1:2948 HOGAN DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6078
Practice Address - Country:US
Practice Address - Phone:307-258-9426
Practice Address - Fax:307-224-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1212261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21514OtherMEDICARE NUMBER
WY1558553339Medicaid