Provider Demographics
NPI:1265760714
Name:CASTLE ROCK PHYSICAL THERAPY
Entity type:Organization
Organization Name:CASTLE ROCK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-872-4530
Mailing Address - Street 1:1400 UINTA DR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-5060
Mailing Address - Country:US
Mailing Address - Phone:307-872-4500
Mailing Address - Fax:307-872-4595
Practice Address - Street 1:1400 UINTA DR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5060
Practice Address - Country:US
Practice Address - Phone:307-872-4500
Practice Address - Fax:307-872-4595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTLE ROCK SPECIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1064282-02Medicaid