Healthcare Provider Details

I. General information

NPI: 1902892409
Provider Name (Legal Business Name): PRAIRIE REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S CLIFF AVE
SIOUX FALLS SD
57105-2129
US

IV. Provider business mailing address

1720 S CLIFF AVE
SIOUX FALLS SD
57105-2129
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-5630
  • Fax: 605-332-5327
Mailing address:
  • Phone: 605-334-5630
  • Fax: 605-332-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number022510002
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0225410001
License Number StateSD

VIII. Authorized Official

Name: LEE S GLASOE
Title or Position: ADMINISTRATOR
Credential: OTR/L, CHT
Phone: 605-334-5630