Healthcare Provider Details

I. General information

NPI: 1992424683
Provider Name (Legal Business Name): PRAIRIE REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E HOLLY BLVD
BRANDON SD
57005-1359
US

IV. Provider business mailing address

1720 S CLIFF AVE
SIOUX FALLS SD
57105-2129
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-3103
  • Fax: 605-582-3885
Mailing address:
  • Phone: 605-339-0729
  • Fax: 605-335-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LEE S GLASOE
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-334-5630