Basic Information
| Provider Information | |||||||||
| NPI: | 1306938097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STECKER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 LINDSAY LN | ||||||||
| Address2: | |||||||||
| City: | CODY | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824144103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075781970 | ||||||||
| FaxNumber: | 3075781973 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 LINDSAY LN | ||||||||
| Address2: | |||||||||
| City: | CODY | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824144103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075781970 | ||||||||
| FaxNumber: | 3075781973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-1141 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 315269 | 01 | WY | BLUE CROSS BLUE SHIELD | OTHER | 23926 | 01 | WY | WINHEALTH PARTNERS | OTHER |