| Optimal Aqua Therapy, LLC | |
|
611 E Carlson St Ste 117d Cheyenne WY 82009-4311 | |
| (307) 514-0510 | |
| (307) 514-2941 |
| Full Name | Optimal Aqua Therapy, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 611 E Carlson St Ste 117d, Cheyenne, Wyoming |
| Authorized Official Name and Position | Paul Jordan Washburn (DIRECTOR) |
| Authorized Official Contact | 3075140510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Aqua Therapy, LLC 611 E Carlson St Ste 117d Cheyenne WY 82009-4311 Ph: (307) 514-0510 | Optimal Aqua Therapy, LLC 611 E Carlson St Ste 117d Cheyenne WY 82009-4311 Ph: (307) 514-0510 |
| NPI Number | 1700408192 |
|---|---|
| Provider Enumeration Date | 05/08/2020 |
| Last Update Date | 05/08/2020 |
| Certification Date | 05/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700408192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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