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NPI Code Detail

MEDICARE: DR. TIAL ANN DONOVAN DPT

MEDICARE: DR. TIAL ANN DONOVAN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1114576949
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIAL ANN DONOVAN DPT
Provider Business Mailing Address
First Line : 4650 WILLIAMS ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57703-6380
Country : US
Telephone Number : 605-769-0574
Fax Number :
Provider Business Practice Location Address
First Line : 2000 WESLEYAN BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-9340
Country : US
Telephone Number : 605-343-3555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2019
Last Update Date : 09/04/2019

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Directions to “ DR. TIAL ANN DONOVAN DPT” Practice Location

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