Basic Information
| Provider Information | |||||||||
| NPI: | 1063645232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAYCSIR | ||||||||
| FirstName: | STEPHENIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEANS | ||||||||
| OtherFirstName: | STEPHENIE | ||||||||
| OtherMiddleName: | JO | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 W LAKEWAY RD | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827186361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076824900 | ||||||||
| FaxNumber: | 3076824996 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W LAKEWAY RD | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827186361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076824900 | ||||||||
| FaxNumber: | 3076824996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2009 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1322 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.