Provider Demographics
NPI:1174989420
Name:FLETCHER, JOANNA (LAT/ ATC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LAT/ ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W TIMOTHY ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5870
Mailing Address - Country:US
Mailing Address - Phone:307-689-2527
Mailing Address - Fax:
Practice Address - Street 1:117 W TIMOTHY ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5870
Practice Address - Country:US
Practice Address - Phone:307-689-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0962255A2300X
TXAT41342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer