Healthcare Provider Details

I. General information

NPI: 1316451859
Provider Name (Legal Business Name): SPEARFISH PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MAIN ST STE 2
SPEARFISH SD
57783-2334
US

IV. Provider business mailing address

305 N MAIN ST STE 2
SPEARFISH SD
57783-2334
US

V. Phone/Fax

Practice location:
  • Phone: 605-559-0381
  • Fax: 605-559-0452
Mailing address:
  • Phone: 605-559-0381
  • Fax: 605-559-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1413
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRANDIE RAINBOTH
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: DPT, OCS
Phone: 605-381-3522