Healthcare Provider Details

I. General information

NPI: 1831545599
Provider Name (Legal Business Name): MORGAN BLASIUS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 DERDALL DR
BROOKINGS SD
57006-2851
US

IV. Provider business mailing address

2218 DERDALL DR
BROOKINGS SD
57006-2851
US

V. Phone/Fax

Practice location:
  • Phone: 605-697-5145
  • Fax: 605-697-5135
Mailing address:
  • Phone: 605-697-5145
  • Fax: 605-697-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1913
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: