Basic Information
| Provider Information | |||||||||
| NPI: | 1861877748 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOP THERAPY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1406 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074630462 | ||||||||
| FaxNumber: | 3074632010 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 E CARLSON ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820094443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075149999 | ||||||||
| FaxNumber: | 3075146006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2015 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | HEGWOOD | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3074630462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.