Healthcare Provider Details

I. General information

NPI: 1134299001
Provider Name (Legal Business Name): SANDRA M. KUTSCHER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 22ND AVE
BROOKINGS SD
57006-2497
US

IV. Provider business mailing address

400 22ND AVE
BROOKINGS SD
57006-2497
US

V. Phone/Fax

Practice location:
  • Phone: 605-697-9500
  • Fax: 605-697-6939
Mailing address:
  • Phone: 605-697-9500
  • Fax: 605-697-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1331
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: