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Organization Active NPI

Wyoming Physical Therapy PC

Doing business as Brookside Physical Therapy

  • Specialist
  • Cheyenne, WY
National Provider Identifier
1467515882
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
WYOMING PHYSICAL THERAPY PC
Doing business as
Brookside Physical Therapy
Practice address
1217 S Greeley Hwy
Suite a
Cheyenne, WY 82007-3034
Phone
(307) 772-0955
Fax
(307) 772-0953
NPI assigned
Dec 18, 2006
Last updated
Dec 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Authorized official

Name
Walter Wilson
Title
Owner
Phone
(720) 223-6177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1217 S Greeley Hwy
Suite a
Cheyenne, WY 82007-3034

Mailing address

1217 S Greeley Hwy
Suite a
Cheyenne, WY 82007-3034
Phone (307) 772-0955

Other practice location 1

140 Boardwalk Dr Unit A
Fort Collins, CO 80525-3153
Phone (970) 223-8293

Other identifiers 1

IdentifierTypeStateIssuer
114492800MedicaidWY

Other names 1

  • Brookside Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070316000249 WY Part B Supplier - Clinic/Group Practice 1355444084 Receives reassigned benefits from 5 practitioners
Practice locations: Cheyenne, WY; Pine Bluffs, WY
O20190227001850 CO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1355444084 Receives reassigned benefits from 11 practitioners
Practice locations: Colorado Springs, CO; Centennial, CO; Westminster, CO; Fort Collins, CO; Denver, CO

National Provider Directory

National Provider Directory
Tax ID family
Brookside Physical Therapy14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

7340 E Caley Ave
Centennial, CO 80111
Phone (720) 598-5512

1157 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 266-1710

4935 N 30th St
Ste 100
Colorado Springs, CO 80919
Phone (719) 266-1710

3001 S 23rd Ave
Greeley, CO 80631
Phone (970) 541-2851

910 E Eisenhower Blvd
Loveland, CO 80537
Phone (970) 461-8662

10747 W 108th Ave
Westminster, CO 80021
Phone (303) 256-2505

1217 S Greeley Hwy
Ste A
Cheyenne, WY 82007
Phone (307) 772-0955

1612 E Pershing Blvd
Cheyenne, WY 82001

611 E Carlson St
Ste 117
Cheyenne, WY 82009
Phone (307) 514-0510

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1467515882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 S GREELEY HWY",
            "address_2": "SUITE A",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820073034",
            "telephone_number": "307-772-0955",
            "fax_number": "307-772-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 S GREELEY HWY",
            "address_2": "SUITE A",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820073034",
            "telephone_number": "307-772-0955",
            "fax_number": "307-772-0953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 Boardwalk Dr Unit A",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805253153",
            "country_code": "US",
            "telephone_number": "970-223-8293",
            "fax_number": "970-223-8219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WYOMING PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-223-6177"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114492800",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.