MEDICARE: BRETT D TEVELDAL PT

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1042	SD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27416	OTHER	SD	SIOUX VALLEY HEALTH PLAN
3	4994832	OTHER	SD	BLUE CROSS BLUE SHIELD SD
4	64-03937	OTHER	SD	MEDICA
5	64-04055	OTHER	SD	MEDICA
6	361J8TE	OTHER	SD	BLUE CROSS BLUE SHIELD MN
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	64-03936	OTHER	SD	MEDICA
9	1042.1	OTHER	SD	DAKOTACARE
10	1810856	OTHER	SD	ARAZ
11	4996126	OTHER	SD	BLUE CROSS BLUE SHIELD SD
12	64-05333	OTHER	SD	MEDICA
13	4996418	OTHER	SD	BLUE CROSS BLUE SHIELD SD
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1144216458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT D TEVELDAL PT

Provider Business Mailing Address
First Line	:	1720 S CLIFF AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2129
Country	:	US
Telephone Number	:	605-334-5630
Fax Number	:	605-332-5327

Provider Business Practice Location Address
First Line	:	1720 S CLIFF AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2129
Country	:	US
Telephone Number	:	605-334-5630
Fax Number	:	605-332-5327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/08/2007

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1720 S CLIFF AVE
SIOUX FALLS, SD
57105-2129