=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457062283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRELL BARNETT LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2022
-----------------------------------------------------
Last Update Date | 12/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 E CAPITOL AVE STE 201B
-----------------------------------------------------
City | PIERRE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57501-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-600-3553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 514 AMERICAS WAY STE 14940
-----------------------------------------------------
City | BOX ELDER
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57719-7600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-600-3553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT11849
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------