Healthcare Provider Details

I. General information

NPI: 1619830304
Provider Name (Legal Business Name): DYLAN KALLHOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W 69TH ST UNIT 102
SIOUX FALLS SD
57108-5622
US

IV. Provider business mailing address

5705 S BAHNSON AVE UNIT 4
SIOUX FALLS SD
57108-2799
US

V. Phone/Fax

Practice location:
  • Phone: 605-782-9436
  • Fax:
Mailing address:
  • Phone: 605-215-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6235
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: