Healthcare Provider Details

I. General information

NPI: 1932183308
Provider Name (Legal Business Name): THE REHAB DOCTORS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 JACKSON BLVD SUITE 3
RAPID CITY SD
57702-4397
US

IV. Provider business mailing address

1136 JACKSON BLVD
RAPID CITY SD
57702-4396
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-7246
  • Fax: 605-341-4501
Mailing address:
  • Phone: 605-721-7246
  • Fax: 605-341-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5300141945007EUF001
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5300141945007EUT001
License Number StateSD

VIII. Authorized Official

Name: CHRISTOPHER T DIETRICH
Title or Position: PRESIDENT OF CORPORATION
Credential: MD
Phone: 605-721-7246