Healthcare Provider Details

I. General information

NPI: 1730482001
Provider Name (Legal Business Name): BARBARA LOUISE DEAN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 W. MAIN ST. STE 1
RAPID CITY SD
57702-2465
US

IV. Provider business mailing address

2120 W. MAIN ST. STE 1
RAPID CITY SD
57702-2465
US

V. Phone/Fax

Practice location:
  • Phone: 605-718-5720
  • Fax: 605-718-5720
Mailing address:
  • Phone: 605-718-5720
  • Fax: 605-718-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number904
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: