Wyoming Specialized Physical Therapy Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

WYOMING SPECIALIZED PHYSICAL THERAPY INC.

Practice address

620 W Cheyenne Dr.
Evanston, WY 82930-5505

Phone

(307) 789-8860

Fax

(307) 789-8394

NPI assigned

Aug 12, 2006

Last updated

Nov 1, 2021By 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

Michael G Jacketta, DPT OCSNPI 1134131055

Title

Owner

Phone

(307) 789-8860

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 8

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.

• Michael Gene Jacketta, MPT, OCS

  • Physical Therapist
  • Evanston, WY
  • NPI 1134131055
  Medicare reassignment Care Compare group NPD Authorized official
• Carol Diane Davis, OTR/L

  • Occupational Therapist
  • Evanston, WY
  • NPI 1437515285
  Medicare reassignment Care Compare group NPD
• Brian Dee Redden, DPT

  • Physical Therapist
  • Urie, WY
  • NPI 1689989055
  Medicare reassignment NPD
• Matt Thomas Lowell, MPT

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1811022148

  WY

  Medicare reassignment NPD
• Savannah Jeske

  • Physical Therapy Assistant
  • Evanston, WY
  • NPI 1932730405
  NPD
• Daren Lavel Martin, MPT

  • Physical Therapist
  • Rock Springs, WY
  • NPI 1750593703
  NPD (past)
• Breeann Vernon Allred, D.P.T

  • Physical Therapist
  • Logan, UT
  • NPI 1932393261
  NPD (past)
• Adam B. Kershaw, MPT, OCS

  • Physical Therapist
  • Bremerton, WA
  • NPI 1205848223
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1336151265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W CHEYENNE DR.",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305505",
            "telephone_number": "307-789-8860",
            "fax_number": "307-789-8394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W CHEYENNE DR.",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305505",
            "telephone_number": "307-789-8860",
            "fax_number": "307-789-8394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING SPECIALIZED PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "JACKETTA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-789-8860",
        "authorized_official_credential": "DPT OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118279000",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandie Lea Wood
• Vickie L Wood, LCSW
• Desiree Workman
• Wraparound Solutions LLC
• Wyoming Range Rehab Center LLC
• Wyoming State Hospital
• Gregory M Yasuda, MD
• Gennifer L Young, OTR
• Judy Young
• Sara June Young, PMHNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.