Healthcare Provider Details

I. General information

NPI: 1467759761
Provider Name (Legal Business Name): TIMOTHY L FAIMAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 STURGIS RD
RAPID CITY SD
57702-2345
US

IV. Provider business mailing address

3535 STURGIS RD
RAPID CITY SD
57702-2345
US

V. Phone/Fax

Practice location:
  • Phone: 605-920-0373
  • Fax:
Mailing address:
  • Phone: 605-920-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number56
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: