Healthcare Provider Details

I. General information

NPI: 1952079220
Provider Name (Legal Business Name): NOAH A FAGERLUND PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BUNCOMBE DR
ROCK RAPIDS IA
51246-1003
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 712-472-3333
  • Fax:
Mailing address:
  • Phone: 605-328-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2352
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: