MEDICARE: BRYCE GADES

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	225100000X	Physical Therapist	1773	SD

General Provider Information

NPI Number	:	1366850570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYCE GADES

Provider Business Mailing Address
First Line	:	113 COMANCHE RD
Second Line	:
City	:	FORT MEADE
State	:	SD
Zip	:	57741-1002
Country	:	US
Telephone Number	:	605-347-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 5TH AVE
Second Line	:	SUITE 202
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-6031
Country	:	US
Telephone Number	:	605-723-0185
Fax Number	:	605-723-0186

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	03/20/2024

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Directions to “ BRYCE GADES ” Practice Location

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