Blacks Fork Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

BLACKS FORK PHYSICAL THERAPY LLC

Practice address

195 Feather Way
Evanston, WY 82930-9352

Phone

(307) 679-4959

NPI assigned

Jan 9, 2019

Organization subpart

No

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

Authorized official

Name

Brady S. Stokes, PTNPI 1972074607

Title

Physical Therapist/Owner

Phone

(307) 679-4959

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

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

• Brady Scott Stokes, PT, DPT, CIDN

  • Physical Therapist
  • Evanston, WY
  • NPI 1972074607
  Medicare reassignment Care Compare group NPD Authorized official
• Lance Chappell, DPT

  • Physical Therapist
  • Evanston, WY
  • NPI 1720690258
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1546992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1629541982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3792 ALMY ROAD 107",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829308940",
            "telephone_number": "307-679-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 FEATHER WAY",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309352",
            "telephone_number": "307-679-4959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKS FORK PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-09",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "STOKES",
        "authorized_official_first_name": "BRADY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "307-679-4959",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mary Hansen Boal, LAT, NCACII, BSW
• Jessica Bond, RN
• Kortney Booth Clark, CASE MANAGEMENT
• Ashleigh Choi Bott, PSY.D.

• All providers in Evanston, WY
• Physical Therapy Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.