NPIMap

Organization Active NPI

Four Pines Physical Therapy PC

  • Physical Therapist
  • Jackson, WY
National Provider Identifier
1013090539
Registry record updated Nov 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FOUR PINES PHYSICAL THERAPY PC
Practice address
1090 S Hwy 89
Jackson, WY 83001
Phone
(307) 733-5577
Fax
(307) 733-5505
NPI assigned
Oct 21, 2006
Last updated
Nov 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Virginia Norene Christensen, PT MS OCSNPI 1992888416
Title
Owner President
Phone
(307) 733-5577

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

1090 S Hwy 89
Jackson, WY 83001

Mailing address

PO Box 8467
Jackson, WY 83002-8467
Phone (307) 733-5577

Other identifiers 2

IdentifierTypeStateIssuer
113731000MedicaidWY
307976OtherWYBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609000915 WY Part B Supplier - Clinic/Group Practice 8224011424 Receives reassigned benefits from 18 practitioners
Practice locations: Alpine, WY; Jackson, WY; Pinedale, WY

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322524800000",
    "number": "1013090539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8467",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830028467",
            "telephone_number": "307-733-5577",
            "fax_number": "307-733-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 S HWY 89",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-733-5577",
            "fax_number": "307-733-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR PINES PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2011-11-29",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "NORENE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "307-733-5577",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT MS OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113731000",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "307976",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.