Red Tail Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

RED TAIL THERAPY LLC

Doing business as

Red Tail Therapy

Practice address

350 S Washington St Unit 5
Afton, WY 83110-5106

Phone

(307) 254-1353

NPI assigned

Jun 22, 2022

Organization subpart

No

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

Authorized official

Name

Kenneth Smith, PTNPI 1558838185

Title

Ceo, Physical Therapist

Phone

(307) 368-2300

Specialties & licenses 1

Addresses

Other names 1

• Red Tail Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Practitioners 1

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

• Kenneth Smith, PT

  • Physical Therapist
  • Thayne, WY
  • NPI 1558838185
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1655856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1710618483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1111",
            "city": "AFTON",
            "state": "WY",
            "postal_code": "831101111",
            "telephone_number": "307-254-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S WASHINGTON ST UNIT 5",
            "city": "AFTON",
            "state": "WY",
            "postal_code": "831105106",
            "telephone_number": "307-254-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED TAIL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-22",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "307-368-2300",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Tail Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Red Tail Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• PPM Wyoming LLC
• Quality Case Management
• Quality Case Management Inc
• Dee J Rammell
• Tamara Rammell
• Daniel Boyd Richons, RPH
• Melissa Diane Robbins-Hutchison, LPC
• Jared Andrew Rose, DPT
• Jeffrey V Rosenberg, DO
• G. Nohl Sandall, PH. D.

• Physical Therapist in Afton, WY
• Providers in Afton, WY by specialty
• Physical Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.