Healthcare Provider Details

I. General information

NPI: 1801340294
Provider Name (Legal Business Name): JASON A BEILSTEIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 12/12/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 PEACEFUL PINES RD STE 4
BLACK HAWK SD
57718-9556
US

IV. Provider business mailing address

18 E KANSAS CITY ST #101
RAPID CITY SD
57701-2971
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-1300
  • Fax: 605-737-0874
Mailing address:
  • Phone: 605-348-9530
  • Fax: 605-737-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1927
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: