Core 307 PT LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1435 Issued in WY

Legal business name

CORE 307 PT LLC

Practice address

548 Running W Dr
Gillette, WY 82718-2074

Phone

(307) 670-9444

Fax

(307) 670-9188

NPI assigned

May 10, 2018

Last updated

May 10, 2018By 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

Mrs. Tiffany Carol Callaway

Title

Office Manager

Phone

(307) 670-9444

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 5

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.

• Brittany J Farella, PT

  • Physical Therapist
  • Gillette, WY
  • NPI 1417202706
  Medicare reassignment
• Jessica Marie Long, PTA

  • Physical Therapy Assistant
  • Gillette, WY
  • NPI 1811758204
  NPD
• Danielle Gray, PTA

  • Physical Therapist
  • Gillette, WY
  • NPI 1700399722
  NPD (past)
• Jamie L Hendryx, D.P.T.

  • Physical Therapist
  • Gillette, WY
  • NPI 1669505061
  NPD (past)
• Kayla Anne Williamsen, PHYSICAL THERAPIST

  • Physical Therapist
  • Gillette, WY
  • NPI 1740569185
  NPD (past)

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525910400000",
    "number": "1801386370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 RUNNING W DR",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827182074",
            "telephone_number": "307-670-9444",
            "fax_number": "307-670-9188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "548 RUNNING W DR",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827182074",
            "telephone_number": "307-670-9444",
            "fax_number": "307-670-9188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE 307 PT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-05-10",
        "status": "A",
        "authorized_official_last_name": "CALLAWAY",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "307-670-9444",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "1435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; 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.