NPIMap

Organization Active NPI

Gillette Physical Therapy PC

  • Physical Therapist
  • Gillette, WY
National Provider Identifier
1154379998
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GILLETTE PHYSICAL THERAPY PC
Practice address
1013 East Boxelder
Gillette, WY 82718-5536
Phone
(307) 682-4900
Fax
(307) 687-7243
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Authorized official

Name
Mr. Kenneth L Clouston, DPTNPI 1841390721
Title
Partner
Phone
(307) 682-4900

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1013 East Boxelder
Gillette, WY 82718-5536

Mailing address

PO Box 7132
Gillette, WY 82717-7132
Phone (307) 682-4900

Other identifiers 1

IdentifierTypeStateIssuer
120766100MedicaidWY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050526000791 WY Part B Supplier - Clinic/Group Practice 0345282570 Receives reassigned benefits from 11 practitioners
Practice locations: Casper, WY; Gillette, WY

National Provider Directory

National Provider Directory

Locations

1013 E Boxelder Rd
Ste 200
Gillette, WY 82718
Phone (307) 257-7620

1013 E Boxelder Rd
Gillette, WY 82718
Phone (307) 682-4900

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1154379998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7132",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827177132",
            "telephone_number": "307-682-4900",
            "fax_number": "307-687-7243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 EAST BOXELDER",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185536",
            "telephone_number": "307-682-4900",
            "fax_number": "307-687-7243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLETTE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "CLOUSTON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "307-682-4900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120766100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; 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.