Healthcare Provider Details

I. General information

NPI: 1588592240
Provider Name (Legal Business Name): MATTHEW SUMNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 W 57TH ST STE 3
SIOUX FALLS SD
57108-2893
US

IV. Provider business mailing address

1905 W 57TH ST STE 3
SIOUX FALLS SD
57108-2893
US

V. Phone/Fax

Practice location:
  • Phone: 605-371-3533
  • Fax: 605-371-1781
Mailing address:
  • Phone: 605-371-3533
  • Fax: 605-371-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT11066
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: