Healthcare Provider Details

I. General information

NPI: 1013823442
Provider Name (Legal Business Name): APOLLO COLLINS WEDDELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W. HIGHWAY 46
WAGNER SD
57380
US

IV. Provider business mailing address

515 W. HIGHWAY 46
WAGNER SD
57380
US

V. Phone/Fax

Practice location:
  • Phone: 605-384-3661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6138
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: