Healthcare Provider Details

I. General information

NPI: 1609262005
Provider Name (Legal Business Name): ERIN RUTH HEDEEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHURCH ST
ALCESTER SD
57001-2134
US

IV. Provider business mailing address

310 S 3RD ST
BERESFORD SD
57004-2104
US

V. Phone/Fax

Practice location:
  • Phone: 605-934-2500
  • Fax: 605-934-2307
Mailing address:
  • Phone: 605-214-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0386
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: