Active NPI
Diane Janicki, R.P.T
- Physical Therapist
- Green River, WY
National Provider Identifier
1306008081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 218
- Practice address
- 140 Commerce Dr
Green River, WY 82935-6178 - Phone
- (307) 875-8492
- Fax
- (307) 875-7389
- NPI assigned
- Jun 25, 2008
- Last updated
- Jun 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 218 | WY | Primary |
Addresses
Primary practice location
140 Commerce Dr
Green River, WY 82935-6178
Mailing address
PO Box 1497
Green River, WY 82935-1497
Phone (307) 875-8492
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110936700 | Medicaid | WY |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 218 | WY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1306008081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1497",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829351497",
"telephone_number": "307-875-8492",
"fax_number": "307-875-7389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 COMMERCE DR",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829356178",
"telephone_number": "307-875-8492",
"fax_number": "307-875-7389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANICKI",
"first_name": "DIANE",
"credential": "R.P.T",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-25",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WY",
"license": "218",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110936700",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green River, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.