Blacks Fork Physical Therapy Llc - Medicare in Evanston, WY

Blacks Fork Physical Therapy Llc is a medicare enrolled "Clinic/center - Physical Therapy" provider in Evanston, Wyoming. Their current practice location is 195 Feather Way, Evanston, Wyoming. You can reach out to their office (for appointments etc.) via phone at (307) 679-4959.

Blacks Fork Physical Therapy Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Blacks Fork Physical Therapy Llc is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1629541982.

Contact Information

Blacks Fork Physical Therapy Llc
195 Feather Way,
Evanston, WY 82930-9352
(307) 679-4959
Not Available



Healthcare Provider's Profile

Full NameBlacks Fork Physical Therapy Llc
TypeFacility
SpecialityClinic/center - Physical Therapy
Location195 Feather Way, Evanston, Wyoming
Accepts Medicare AssignmentsMedicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1629541982
  • Provider Enumeration Date: 01/09/2019
  • Last Update Date: 01/09/2019
  Medicare PECOS Information:
  • PECOS PAC ID: 4284977349
  • Enrollment ID: O20190514000958

Medical Identifiers

Medical identifiers for Blacks Fork Physical Therapy Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1629541982NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
225100000XPhysical Therapist (* (Not Available))Secondary
261QP2000XClinic/center - Physical Therapy (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Blacks Fork Physical Therapy Llc acts as a billing entity for following providers:
Provider NameBrady Scott Stokes
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1972074607
PECOS PAC ID: 9436492501
Enrollment ID: I20190514001367

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Provider NameLance O Chappell
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1720690258
PECOS PAC ID: 1951719632
Enrollment ID: I20210419000569

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Provider NameColby Kim Gomez
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1598398935
PECOS PAC ID: 6901260132
Enrollment ID: I20230906003994

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Blacks Fork Physical Therapy Llc is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Blacks Fork Physical Therapy Llc
3792 Almy Road 107,
Evanston, WY 82930-8940

Ph: (307) 679-4959
Blacks Fork Physical Therapy Llc
195 Feather Way,
Evanston, WY 82930-9352

Ph: (307) 679-4959

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› Verified 9 days ago



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