Healthcare Provider Details

I. General information

NPI: 1801103361
Provider Name (Legal Business Name): MICHELE PIERCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 09/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

IV. Provider business mailing address

103 W DIVISION ST P.O. BOX 56
ANTHON IA
51004-8192
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-2770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0285
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001413
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: