Healthcare Provider Details

I. General information

NPI: 1427977032
Provider Name (Legal Business Name): SHILO ANNE WYMBS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 COLUMBUS ST
RAPID CITY SD
57701-3407
US

IV. Provider business mailing address

807 COLUMBUS ST
RAPID CITY SD
57701-3407
US

V. Phone/Fax

Practice location:
  • Phone: 605-858-9571
  • Fax:
Mailing address:
  • Phone: 605-858-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT12260
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: