Healthcare Provider Details

I. General information

NPI: 1629233721
Provider Name (Legal Business Name): DETERT ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W ASHCROFT ST
SIOUX FALLS SD
57108-2520
US

IV. Provider business mailing address

708 W ASHCROFT ST
SIOUX FALLS SD
57108-2520
US

V. Phone/Fax

Practice location:
  • Phone: 605-274-6933
  • Fax: 605-274-6933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0893
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. KRISTIN JO DETERT
Title or Position: OWNER
Credential:
Phone: 605-274-6933