Optimal Aqua Therapy, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

OPTIMAL AQUA THERAPY, LLC

Practice address

611 E Carlson St Ste 117D
Cheyenne, WY 82009-4311

Phone

(307) 514-0510

Fax

(307) 514-2941

NPI assigned

May 8, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Paul Jordan Washburn, MD, MPH

Title

Director

Phone

(307) 514-0510

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1588896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1700408192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E CARLSON ST STE 117D",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094311",
            "telephone_number": "307-514-0510",
            "fax_number": "307-514-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E CARLSON ST STE 117D",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094311",
            "telephone_number": "307-514-0510",
            "fax_number": "307-514-2941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL AQUA THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-08",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "WASHBURN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JORDAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "307-514-0510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Cheyenne",
            "affiliation": "N",
            "address_1": "611 E Carlson St Ste 117D",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820094311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Internal Medicine Physician in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Internal Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.