Healthcare Provider Details

I. General information

NPI: 1588974315
Provider Name (Legal Business Name): KRISTIN MARY ELLENBECKER RIPPERDA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

IV. Provider business mailing address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5890
  • Fax: 605-336-3974
Mailing address:
  • Phone: 605-331-5890
  • Fax: 605-336-3974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number894
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5838690
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: