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NPI Code Detail

MEDICARE: DR. CAROL MARIE RISDALL DPT

MEDICARE: DR. CAROL MARIE RISDALL DPT
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
1225100000XPhysical Therapist0275SD

General Provider Information

NPI Number : 1053571042
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL MARIE RISDALL DPT
Provider Business Mailing Address
First Line : 1530 FOREST HILLS DR
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-4449
Country : US
Telephone Number : 605-388-9335
Fax Number :
Provider Business Practice Location Address
First Line : 1530 FOREST HILLS DR
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-4449
Country : US
Telephone Number : 605-388-9335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2008
Last Update Date : 06/12/2008

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Directions to “ DR. CAROL MARIE RISDALL DPT” Practice Location

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