NPIMap

Organization Active NPI

Fremont Therapy Group LLC

  • Physical Therapist
  • Riverton, WY
National Provider Identifier
1477568046
Registry record updated Oct 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FREMONT THERAPY GROUP LLC
Practice address
2002 West Sunset Drive
Suite 1
Riverton, WY 82501
Phone
(307) 856-7021
Fax
(307) 856-5546
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2010

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

Authorized official

Name
Scott E Phister, MPT
Title
Owner
Phone
(307) 856-7021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2002 West Sunset Drive
Suite 1
Riverton, WY 82501

Mailing address

2002 West Sunset Drive
Suite 1
Riverton, WY 82501
Phone (307) 856-7021

Other identifiers 5

IdentifierTypeStateIssuer
111952400MedicaidWY
303969OtherWYBLUE CROSS BLUE SHIELD
1524243OtherUNITED MINEWORKERS
185794800OtherACS DEPT OF LABOR
C65268OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608000562 WY Part B Supplier - Clinic/Group Practice 5092798488 Receives reassigned benefits from 17 practitioners
Practice locations: Rock Springs, WY; Riverton, WY; Rawlins, WY; Lander, WY; Green River, WY

National Provider Directory

National Provider Directory

Locations

511 N 12th St E
Ste A
Riverton, WY 82501
Phone (307) 856-7021

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286496000000",
    "number": "1477568046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 WEST SUNSET DRIVE",
            "address_2": "SUITE 1",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "82501",
            "telephone_number": "307-856-7021",
            "fax_number": "307-856-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 WEST SUNSET DRIVE",
            "address_2": "SUITE 1",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "82501",
            "telephone_number": "307-856-7021",
            "fax_number": "307-856-5546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT THERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2010-10-08",
        "status": "A",
        "authorized_official_last_name": "PHISTER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-856-7021",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111952400",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "303969",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED MINEWORKERS",
            "identifier": "1524243",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS DEPT OF LABOR",
            "identifier": "185794800",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "C65268",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverton, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; 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.