Healthcare Provider Details

I. General information

NPI: 1245304435
Provider Name (Legal Business Name): HOVDES PHYSICAL THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 1ST AVE W
CLARK SD
57225-1405
US

IV. Provider business mailing address

312 1ST AVE W
CLARK SD
57225-1405
US

V. Phone/Fax

Practice location:
  • Phone: 605-532-4212
  • Fax: 605-532-1343
Mailing address:
  • Phone: 605-532-4212
  • Fax: 605-532-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1194
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0799
License Number StateSD

VIII. Authorized Official

Name: MS. SANDRA HOVDE
Title or Position: PHYSICAL THERAPIST OWNER
Credential: PT
Phone: 605-532-4212