MEDICARE: CAILEY IVERSON 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
1	225100000X	Physical Therapist	2438	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2438	OTHER	SD	PHYSICAL THERAPIST LICENSE NUMBER

General Provider Information

NPI Number	:	1831829498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAILEY IVERSON DPT

Provider Business Mailing Address
First Line	:	511 NATIONAL ST
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1836
Country	:	US
Telephone Number	:	605-723-0185
Fax Number	:	605-723-0186

Provider Business Practice Location Address
First Line	:	511 NATIONAL ST
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1836
Country	:	US
Telephone Number	:	605-723-0185
Fax Number	:	605-723-0186

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	02/19/2024

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