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.
Healthcare Provider's Profile
| Full Name | Blacks Fork Physical Therapy Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Physical Therapy |
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| Location | 195 Feather Way, Evanston, Wyoming |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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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.
| Identifier | Type | State | Issuer |
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| 1629541982 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/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 Name | Brady Scott Stokes |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1972074607
PECOS PAC ID: 9436492501
Enrollment ID: I20190514001367 |
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| Provider Name | Lance O Chappell |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1720690258
PECOS PAC ID: 1951719632
Enrollment ID: I20210419000569 |
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| Provider Name | Colby Kim Gomez |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI 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 Address | Practice Location Address |
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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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