Healthcare Provider Details

I. General information

NPI: 1235121500
Provider Name (Legal Business Name): PTOT PROFESSIONALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 7TH ST
RAPID CITY SD
57701-4661
US

IV. Provider business mailing address

2001 7TH ST
RAPID CITY SD
57701-4661
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-6474
  • Fax: 605-716-6484
Mailing address:
  • Phone: 605-716-6474
  • Fax: 605-716-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0512
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0440
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0462
License Number StateSD

VIII. Authorized Official

Name: MRS. KATHLEEN A BOYLE
Title or Position: PRESIDENT
Credential: OT
Phone: 605-716-6474