Healthcare Provider Details

I. General information

NPI: 1114453339
Provider Name (Legal Business Name): HIGH PLAINS PHYSICAL THERAPY II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 PEACEFUL PINES RD #4
BLACK HAWK SD
57718-9253
US

IV. Provider business mailing address

PO BOX 474
BLACK HAWK SD
57718-0474
US

V. Phone/Fax

Practice location:
  • Phone: 605-348-9530
  • 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateSD

VIII. Authorized Official

Name: CODY A YOUNG
Title or Position: MEMBER/OWNER
Credential: PT
Phone: 605-348-9530