Wyoming Specialized Physical Therapy Inc.
NPI 1336151265ActiveOrganization· Physical Therapist· Evanston, WY
Physical Therapist in Evanston, Wyoming, registered in NPPES in August 2006. The authorized official on file is Michael G. Jacketta, DPT OCS, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1336151265 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 12, 2006 |
| Last updated in NPPES | Nov 1, 2021 |
| Certified by provider | Nov 1, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Physical Therapist, Orthopedic | 2251X0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WY) |
|---|
Other physical therapists in Evanston
- 1134131055
- 1215260096
- 1558515098
- 1598398935
- 1720690258
- 1972074607
- 1699607440
- 1215452958
- 1144815341
- 1316283450
- 1497313563
- 1386183242