Healthcare Provider Details

I. General information

NPI: 1164093670
Provider Name (Legal Business Name): STRESS BUSTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 JACKSON BLVD STE 8
RAPID CITY SD
57702-3474
US

IV. Provider business mailing address

1026 RACINE ST
RAPID CITY SD
57701-1070
US

V. Phone/Fax

Practice location:
  • Phone: 605-646-3685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DIANA MOHR
Title or Position: OWNER
Credential:
Phone: 605-646-3685