Healthcare Provider Details

I. General information

NPI: 1043855158
Provider Name (Legal Business Name): BONITA MARIE ALBRECHT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CALUMET AVE NE
DE SMET SD
57231
US

IV. Provider business mailing address

21692 435TH AVE
DE SMET SD
57231-7015
US

V. Phone/Fax

Practice location:
  • Phone: 605-854-3327
  • Fax:
Mailing address:
  • Phone: 605-203-0296
  • Fax: 605-854-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: