Active Balance Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-0964 Issued in WY

Legal business name

ACTIVE BALANCE PHYSICAL THERAPY, LLC

Practice address

512 Main St
Dayton, WY 82836-5056

Phone

(307) 655-2509

Fax

(370) 655-2275

NPI assigned

Nov 10, 2015

Last updated

Feb 1, 2023By 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

Lisa K Stutzman, PTNPI 1558318592

Title

President

Phone

(307) 655-2509

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Practitioners 3

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.

• Lisa Kay Stutzman, MPT

  • Physical Therapist
  • Dayton, WY
  • NPI 1558318592
  Medicare reassignment Care Compare group NPD Authorized official
• Marye Carlson, PT, DPT

  • Physical Therapist
  • Buffalo, WY
  • NPI 1417732074
  Medicare reassignment Care Compare group NPD
• Leah Mentele, DPT

  • Physical Therapist
  • Dayton, WY
  • NPI 1093376857
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1780057968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1064",
            "city": "DAYTON",
            "state": "WY",
            "postal_code": "828361064",
            "telephone_number": "307-655-2509",
            "fax_number": "307-655-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 MAIN ST",
            "city": "DAYTON",
            "state": "WY",
            "postal_code": "828365056",
            "telephone_number": "307-655-2509",
            "fax_number": "370-655-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE BALANCE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-10",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "STUTZMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-655-2509",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "PT-0964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Renee Fritz, LCSW
• Holistic Community Services-a Different Way
• Aimee J Jolley, M.S. SLP-CCC
• Leah Mentele, DPT
• Cordell Perkins

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; 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.