Healthcare Provider Details

I. General information

NPI: 1740021682
Provider Name (Legal Business Name): MISS JULIA RUTH BERNDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 5TH ST
BROOKINGS SD
57006-2007
US

IV. Provider business mailing address

1037 10TH ST S APT 6
BROOKINGS SD
57006-3900
US

V. Phone/Fax

Practice location:
  • Phone: 605-695-6447
  • Fax:
Mailing address:
  • Phone: 605-695-6447
  • Fax: 605-939-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT12066
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: