Laura A Collebrusco, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

124219 Issued in IA

Practice address

555 E Broadway Ave
Jackson, WY 83001-8640

Phone

(307) 739-7491

Fax

(307) 739-1831

NPI assigned

Jun 5, 2024

Last updated

Jun 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1134960826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-739-7491",
            "fax_number": "307-739-1831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-739-7491",
            "fax_number": "307-739-1831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLEBRUSCO",
        "first_name": "LAURA",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "124219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca E. Cloetta, D.D.S.
• Afton Chavez Cobb, MD
• Maggie Ann Cochran
• Charleigh Elizabeth Cole, MSW
• Sadie H Cole, PH.D.
• Community Entry Services
• Thomas D Concannon, LMFT
• Laura Beth Cooper, MD
• Dane Corry
• County of Teton (Jackson Hole Fire EMS)

• Physical Therapist in Jackson, WY
• Providers in Jackson, WY by specialty
• Physical Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.