Healthcare Provider Details

I. General information

NPI: 1982707527
Provider Name (Legal Business Name): ROBIN R STOCKLAND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WASHINGTON STREET
VIBORG SD
57070-0368
US

IV. Provider business mailing address

315 N WASHINGTON ST PO BOX 368
VIBORG SD
57070-0368
US

V. Phone/Fax

Practice location:
  • Phone: 605-326-5161
  • Fax: 605-326-5734
Mailing address:
  • Phone: 605-326-5161
  • Fax: 605-326-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0279
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier5830232
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: