OPTIMAL AQUA THERAPY, LLC (NPI# 1700408192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700408192 |
| Entity Type | Organization |
| Organization Name | OPTIMAL AQUA THERAPY, LLC |
| Practice Address |
611 E Carlson St Ste 117d Cheyenne WY 82009-4311 |
| Practice Telephone | 3075140510 |
| Practice Fax Number | 3075142941 |
| Mailing Telephone | 3075140510 |
| Mailing Fax Number | 3075142941 |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-05-08 |
| Authorized Official Name | DR. PAUL JORDAN WASHBURN (DIRECTOR) |
| Authorized Official Telephone | 3075140510 |
| Authorized Official Credential | MD, MPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
611 E CARLSON ST STE 117D |
| City | CHEYENNE |
| State | WY |
| Zip Code | 82009-4311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659840841 | King & Associates LLC | Private Vehicle | 2232 Dell Range Blvd 245 #3083 Cheyenne, Cheyenne, WY 82009 | 2018-11-16 |
| 1710495700 | Wyoming Endoscopy Center LLC | Clinic/Center | 7220 Comons Circle, Cheyenne, WY 82009 | 2018-01-12 |
| 1912442682 | Lindsey Thurmes Mccoy | Dietitian, Registered | 2232 Dell Range Blvd Ste 282, Cheyenne, WY 82009 | 2017-01-04 |
| 1306380696 | Alexandra Gill | Social Worker | 3304 East 1-80 Service Rd., Cheyenne, WY 82009 | 2016-12-06 |
| 1104213859 | Jennifer Schwartz | Specialist | 2601 Plain View Rd, Cheyenne, WY 82009 | 2015-04-21 |
| 1861830465 | Tyler Boyd | Dentist | 7209 Commons Cir Unit A, Cheyenne, WY 82009 | 2013-06-05 |
| 1639513351 | Gene E Darnell | Pharmacist | 3702 Del Range Blvd, Cheyenne, WY 82009 | 2013-04-24 |
| 1376891952 | Robert R Kanard | Internal Medicine | 714 Edward Dr, Cheyenne, WY 82009 | 2012-08-29 |
| 1639443336 | Jennifer Alam | Case Manager/Care Coordinator | 3304 E. I80 Service Rd, Cheyenne, WY 82009 | 2012-02-28 |
| 1376815357 | Christina Kay Brown | Licensed Practical Nurse | 3304 E I80 Service Rd, Cheyenne, WY 82009 | 2012-02-06 |
| Find all providers in zip 82009 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659911550 | Optimal Performance Medicine, LLC | Internal Medicine | 611 E Carlson St Ste 117c, Cheyenne, WY 82009-4311 | 2020-01-09 |
| 1518508845 | Stephen G. Jacobson | Internal Medicine | 1331 Jack Ln, Cheyenne, WY 82009-1874 | 2019-10-08 |
| 1376891952 | Robert R Kanard | Internal Medicine | 714 Edward Dr, Cheyenne, WY 82009 | 2012-08-29 |
| 1407114671 | Paul Jordan Washburn | Internal Medicine | 611 E Carlson St Ste B, Cheyenne, WY 82009-4311 | 2012-04-25 |
| 1508162785 | Dominion Health Inc. | Internal Medicine | 109 517th St, Suite 25, Cheyenne, WY 82001 | 2011-02-04 |
| 1861672024 | Mohammed Mazhar-uddin | Internal Medicine | 6143 Shaun Ave, Cheyenne, WY 82009-3534 | 2007-11-05 |
| 1336332519 | Robert Joseph Stuart Jr. | Internal Medicine | 4504 Cottage Lane, Cheyenne, WY 82001 | 2007-08-22 |
| 1659579191 | Trenette Ann Larson Md PC | Internal Medicine | 10115 Branding Iron Dr, Cheyenne, WY 82009-8614 | 2007-07-06 |
| 1346398377 | Paulette Finander | Internal Medicine | 1325 Jessi Drive, Cheyenne, WY 82009 | 2007-01-08 |
| 1043382336 | Dale C Brentlinger | Internal Medicine | 2508 E Fox Farm Road, #1a, Cheyenne, WY 82007 | 2006-11-14 |
| Find all providers in CHEYENNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.