Healthcare Provider Details

I. General information

NPI: 1396805222
Provider Name (Legal Business Name): FLEXIBIL OT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 ENCHANTED PINES DR
RAPID CITY SD
57701-9235
US

IV. Provider business mailing address

4824 ENCHANTED PINES DR
RAPID CITY SD
57701-9235
US

V. Phone/Fax

Practice location:
  • Phone: 605-484-9759
  • Fax: 605-721-5940
Mailing address:
  • Phone: 605-484-9759
  • Fax: 605-721-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number0597
License Number StateSD

VIII. Authorized Official

Name: HOLLI MINER
Title or Position: PRESIDENT
Credential: OT
Phone: 605-484-9759