NPI 1063009272

Sports and Rehabilitation Center of Wyoming LLC

Organisation Rehabilitation Practitioner Jackson, WY

Practice location

Address: 625 E Broadway Ave, Jackson, WY 83001-8642
Phone: (307) 920-1688
Mailing address: 522 N Sweetzer Ave APT 5, Los Angeles, CA 90048-2659

Authorised official

Name: Austin Hammesfahr
Title: Manager
Phone: (310) 307-9670

Registered specialties

Rehabilitation Practitioner Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225400000X

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Registry record

NPI: 1063009272
Entity type: Organization
NPI issued: 22 Dec 2020
Record last updated: 23 May 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.