MEDICARE: 45TH PARALLEL REHABILITATION

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

General Provider Information

NPI Number	:	1629896733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	45TH PARALLEL REHABILITATION

Provider Business Mailing Address
First Line	:	5253 WILHELM RD NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-9518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5253 WILHELM RD NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-9518
Country	:	US
Telephone Number	:	231-590-9103
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. REBECCA WILLIAMS
Credential	:	DPT
Telephone Number	:	231-590-9103

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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