Provider Demographics
NPI:1053718692
Name:YELLOWSTONE PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:YELLOWSTONE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-899-4334
Mailing Address - Street 1:622 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2276
Mailing Address - Country:US
Mailing Address - Phone:307-899-4334
Mailing Address - Fax:
Practice Address - Street 1:622 AVENUE B
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2276
Practice Address - Country:US
Practice Address - Phone:307-899-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty