Provider Demographics
NPI:1194990234
Name:LOGHRY, NICKI ANN (MPT)
Entity type:Individual
Prefix:MRS
First Name:NICKI
Middle Name:ANN
Last Name:LOGHRY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:NICKI
Other - Middle Name:ANN
Other - Last Name:CHRISTOPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3431 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4872
Mailing Address - Country:US
Mailing Address - Phone:307-266-4547
Mailing Address - Fax:
Practice Address - Street 1:3431 BELMONT DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4872
Practice Address - Country:US
Practice Address - Phone:307-266-4547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist