Healthcare Provider Details

I. General information

NPI: 1912059197
Provider Name (Legal Business Name): ANTHONY DAVID SILVA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 UNIVERSITY ST UNIT 9430
SPEARFISH SD
57799-9430
US

IV. Provider business mailing address

1200 UNIVERSITY ST UNIT 9430
SPEARFISH SD
57799-9430
US

V. Phone/Fax

Practice location:
  • Phone: 605-642-6001
  • Fax: 605-642-6539
Mailing address:
  • Phone: 605-642-6001
  • Fax: 605-642-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0043
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: