Healthcare Provider Details

I. General information

NPI: 1902720717
Provider Name (Legal Business Name): SISU SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTH ST
RAPID CITY SD
57701-1247
US

IV. Provider business mailing address

3620 PARKVIEW DR
RAPID CITY SD
57701-7625
US

V. Phone/Fax

Practice location:
  • Phone: 605-484-0706
  • Fax:
Mailing address:
  • Phone: 605-484-0706
  • 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: REBECCA L MAICKI
Title or Position: OWNER
Credential: LMT
Phone: 605-484-0706