Healthcare Provider Details

I. General information

NPI: 1740578376
Provider Name (Legal Business Name): JESSI MUNIZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PEARL ST.
FAULKTON SD
57438
US

IV. Provider business mailing address

PO BOX 501
FAULKTON SD
57438-0501
US

V. Phone/Fax

Practice location:
  • Phone: 605-598-6214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1553
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: