Healthcare Provider Details

I. General information

NPI: 1861862450
Provider Name (Legal Business Name): NATASHA FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 69TH ST
SIOUX FALLS SD
57108-8317
US

IV. Provider business mailing address

1701 E 69TH ST
SIOUX FALLS SD
57108-8317
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-5115
  • Fax:
Mailing address:
  • Phone: 605-332-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT11383
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: