Provider Demographics
NPI:1316998040
Name:NORTH PLATTE PHYSICAL THERAPY SERVICES INC
Entity type:Organization
Organization Name:NORTH PLATTE PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-358-9464
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1790
Mailing Address - Country:US
Mailing Address - Phone:307-358-9464
Mailing Address - Fax:307-358-9330
Practice Address - Street 1:953 WALNUT ST
Practice Address - Street 2:STE A
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2665
Practice Address - Country:US
Practice Address - Phone:307-322-1878
Practice Address - Fax:307-322-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY4650186Medicare ID - Type Unspecified