Healthcare Provider Details

I. General information

NPI: 1265136014
Provider Name (Legal Business Name): PROSPER PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 QUARTZITE AVE
TEA SD
57064-2669
US

IV. Provider business mailing address

420 QUARTZITE AVE
TEA SD
57064-2669
US

V. Phone/Fax

Practice location:
  • Phone: 605-940-1728
  • Fax:
Mailing address:
  • Phone: 605-940-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SARA A PANEK
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 605-940-1728