Healthcare Provider Details

I. General information

NPI: 1073649901
Provider Name (Legal Business Name): DPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 W HAVENS ST
MITCHELL SD
57301-4116
US

IV. Provider business mailing address

1319 W HAVENS ST
MITCHELL SD
57301-4116
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-4778
  • Fax:
Mailing address:
  • Phone: 605-996-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9213206
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTA CARE
# 2
Identifier4998325
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBLUE CROSS BLUE SHIELD
# 3
Identifier5834960
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 4
IdentifierP00278968
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerMEDICARE RAILROAD

VIII. Authorized Official

Name: MR. JOSHUA M MOODY
Title or Position: THERAPIST
Credential: MSPT
Phone: 605-996-4778