MEDICARE: MRS. KRISTI KAY SPORRER PT

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	1357	SD

General Provider Information

NPI Number	:	1639491624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTI KAY SPORRER PT

Provider Business Mailing Address
First Line	:	4805 S DUNLAP AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-7522
Country	:	US
Telephone Number	:	605-351-7262
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 S DUNLAP AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-7522
Country	:	US
Telephone Number	:	605-351-7262
Fax Number	:

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

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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