Healthcare Provider Details

I. General information

NPI: 1912685470
Provider Name (Legal Business Name): LINDA BJORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N PHILLIPS AVE STE 110
SIOUX FALLS SD
57104-6062
US

IV. Provider business mailing address

4801 S BAHA AVE APT 1
SIOUX FALLS SD
57106-2234
US

V. Phone/Fax

Practice location:
  • Phone: 605-545-7175
  • Fax:
Mailing address:
  • Phone: 605-545-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT11707
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: