Impact Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT1568 Issued in WY

Legal business name

IMPACT PHYSICAL THERAPY LLC

Doing business as

Impact Physical Therapy

Practice address

96 Yellow Creek Road
Evanston, WY 82930

Phone

(307) 444-4466

Fax

(307) 444-4468

NPI assigned

Jul 18, 2015

Last updated

Feb 13, 2017By 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

Justin Dennis, DPTNPI 1558515098

Title

Owner

Phone

(801) 209-4466

Specialties & licenses 2

Addresses

Other names 1

• Impact Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 1

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.

• Justin T Dennis, P.T.

  • Physical Therapist
  • Evanston, WY
  • NPI 1558515098
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1699159723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 YELLOW CREEK ROAD",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "82930",
            "telephone_number": "307-444-4466",
            "fax_number": "307-444-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 YELLOW CREEK ROAD",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "82930",
            "telephone_number": "307-444-4466",
            "fax_number": "307-444-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-209-4466",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WY",
            "license": "PT1568",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WY",
            "license": "PT 1683",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impact Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Hunt, CRNA, FNP, APRN
• Katrina Hurst, M.S. CCC-SLP
• Cindy R Hutchings
• Tammy Ibarrat
• Ihc Health Services Inc (IMED Utah Heart - Evanston)
• Innovest Elderly Living, LLC
• Integrity Home Care LLC
• Michael Gene Jacketta, MPT, OCS
• Baylee Lyn Jackson
• Brandon Jaggi, PMHNP

• Physical Therapy Clinic/Center in Evanston, WY
• Providers in Evanston, WY by specialty
• Physical Therapy Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; 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.