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General NPI Number Information
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NPI Number | 1396805222
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Entity Type | Organization
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Legal Business Name | FLEXIBIL OT INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4824 ENCHANTED PINES DR
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City | RAPID CITY
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State | SD
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Zip | 57701-9235
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Country | US
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Telephone | 605-484-9759
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Fax | 605-721-5940
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Provider Business Mailing Address
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Address Line | 4824 ENCHANTED PINES DR
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City | RAPID CITY
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State | SD
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Zip | 57701-9235
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Country | US
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Telephone | 605-484-9759
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Fax | 605-721-5940
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLI MINER
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Credential | OT
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Telephone | 605-484-9759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 0597
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License Number State | SD
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