Individual provider Active NPI

Hannah Lynn Christine Proefrock, PT, DPT

  • Physical Therapist
  • Gillette, WY
National Provider Identifier
1285396382
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2114 Issued in WY
Practice address
902 E 3Rd St
Gillette, WY 82716-4023
Phone
(307) 756-9200
Fax
(307) 756-9203
NPI assigned
Oct 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2114 WY Primary

Addresses

Primary practice location

902 E 3Rd St
Gillette, WY 82716-4023

Mailing address

1103 E Boxelder Rd Ste U
Gillette, WY 82718-5582

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2114WYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Davis Outpatient Therapy LLC Physical Therapist CurrentSince Dec 1, 2021 Accepting new patients
Professional Rehabilitation Center Inc Physical Therapist CurrentSince Oct 6, 2024 Accepting new patients
Power Basin Therapy LLC Physical Therapist Past Accepting new patients
Davis Home Health LLC PastSince Mar 27, 2022 Accepting new patients

Locations

4450 31st Ave S
Ste 104
Fargo, ND 58104
Phone (701) 451-9417

1200 Harwood Dr S
Fargo, ND 58104
Phone (701) 451-4811

902 E 3rd St
Gillette, WY 82716
Phone (307) 756-9200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1285396382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 E BOXELDER RD STE U",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 E 3RD ST",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827164023",
            "telephone_number": "307-756-9200",
            "fax_number": "307-756-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROEFROCK",
        "first_name": "HANNAH",
        "middle_name": "LYNN CHRISTINE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "2114",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 14, 2023; 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.