1992715197 NPI number — ORTHOPEDIC PHYSICAL THERAPY CENTER LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992715197 NPI number — ORTHOPEDIC PHYSICAL THERAPY CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC PHYSICAL THERAPY CENTER LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992715197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 NORTH ROOSEVELT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-725-9900
Provider Business Mailing Address Fax Number:
605-725-9902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 NORTH ROOSEVELT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-725-9900
Provider Business Practice Location Address Fax Number:
605-725-9902
Provider Enumeration Date:
08/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOETZ
Authorized Official First Name:
LEE
Authorized Official Middle Name:
VALENTINE
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
605-725-9900

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  891 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 0435 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4994784 . This is a "BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5830333 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9229263 . This is a "DAKOTA CARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".