Healthcare Provider Details

I. General information

NPI: 1922450394
Provider Name (Legal Business Name): TINY TOTS PT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 W 41ST ST STE 102
SIOUX FALLS SD
57106-5557
US

IV. Provider business mailing address

27805 481ST AVE
CANTON SD
57013-5543
US

V. Phone/Fax

Practice location:
  • Phone: 605-951-0417
  • Fax: 605-356-8075
Mailing address:
  • Phone: 605-951-0417
  • Fax: 605-356-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1151
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1151
License Number StateSD

VIII. Authorized Official

Name: LORI LARSON
Title or Position: PHYSICAL THERAPIST/CEO
Credential: PT
Phone: 320-979-0232