Healthcare Provider Details

I. General information

NPI: 1720130115
Provider Name (Legal Business Name): SANDRA HOVDE II PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/16/2015
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:
Mailing address:
  • Phone: 605-532-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: