Sports and Rehabilitation Center of Wyoming LLC

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Legal business name

SPORTS AND REHABILITATION CENTER OF WYOMING LLC

Practice address

625 E Broadway Ave
Jackson, WY 83001-8642

Phone

(307) 920-1688

NPI assigned

Dec 22, 2020

Organization subpart

No

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

Authorized official

Name

Austin Hammesfahr

Title

Manager

Phone

(310) 307-9670

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621728000000",
    "number": "1063009272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 N SWEETZER AVE APT 5",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900482659",
            "telephone_number": "310-307-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-920-1688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS AND REHABILITATION CENTER OF WYOMING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2021-05-23",
        "certification_date": "2021-05-23",
        "status": "A",
        "authorized_official_last_name": "HAMMESFAHR",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-307-9670"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Practitioner in Jackson, WY
• Providers in Jackson, WY by specialty
• Rehabilitation Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.