Healthcare Provider Details

I. General information

NPI: 1316195209
Provider Name (Legal Business Name): BRIAN WIENK PT, SCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 S SYCAMORE AVE SUITE 150
SIOUX FALLS SD
57110-4532
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 605-231-5590
  • Fax: 605-231-5589
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-590-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0639
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0639
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: