MEDICARE: FLY KIDS PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1003675398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLY KIDS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	412 ALPHA AVE
Second Line	:
City	:	BOX ELDER
State	:	SD
Zip	:	57719-2129
Country	:	US
Telephone Number	:	605-545-2814
Fax Number	:

Provider Business Practice Location Address
First Line	:	2138 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3495
Country	:	US
Telephone Number	:	605-545-2814
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNA FLEISCHACKER
Credential	:	PT, DPT
Telephone Number	:	605-545-2814

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	06/03/2026

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Directions to “FLY KIDS PHYSICAL THERAPY ” Practice Location

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