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General NPI Number Information
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NPI Number | 1184250649
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Entity Type | Individual
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Provider Name | GUY LAWRENCE SIVERSON LMT
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Gender | Male
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1215 MOUNT RUSHMORE RD
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City | RAPID CITY
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State | SD
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Zip | 57701-3660
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Country | US
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Telephone | 605-574-1998
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 MOUNT RUSHMORE RD
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City | RAPID CITY
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State | SD
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Zip | 57701-3660
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Country | US
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Telephone | 605-574-1998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT11684
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License Number State | SD
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