Jackson Hole Sports Recovery LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

JACKSON HOLE SPORTS RECOVERY LLC

Practice address

680 S Cache St Ste 100
Jackson, WY 83001-8694

Phone

(307) 439-4247

NPI assigned

Aug 22, 2020

Last updated

Aug 31, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gianna Risoli, PTNPI 1811329410

Title

Physical Therapist, Owner

Phone

(307) 439-4257

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 1

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.

• Gianna Risoli, P.T.

  • Physical Therapist
  • Jackson, WY
  • NPI 1811329410
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1598054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1255943098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 880",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 S CACHE ST STE 100",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018694",
            "telephone_number": "307-439-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOLE SPORTS RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-22",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "RISOLI",
        "authorized_official_first_name": "GIANNA",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "307-439-4257",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Hole Medical Clinic, LLC (Allergy & Asthma Clinic of Jackson Hole)
• Jackson Hole Medical Imaging, PC (JH Medical Imaging PC)
• Jackson Hole Mental Health LLC
• Jackson Hole OBGYN PC
• Jackson Hole Physical Therapy, PC
• Jackson Hole Surgery
• Jackson Pediatric Associates, LLC (Jackson Pediatrics)
• Jackson Pediatrics P.C.
• Jackson Whole Family Health, Inc.
• William Jackson, RPH

• Physical Therapy Clinic/Center in Jackson, WY
• Providers in Jackson, WY by specialty
• Physical Therapy Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.