MEDICARE: BRITTANY POKALLUS

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
1	225100000X	Physical Therapist	345	AK

General Provider Information

NPI Number	:	1235392150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY POKALLUS

Provider Business Mailing Address
First Line	:	5704 S ANTHONY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2627
Country	:	US
Telephone Number	:	605-360-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 S CLEVELAND AVE
Second Line	:	SUITE 200
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5501
Country	:	US
Telephone Number	:	605-334-8616
Fax Number	:	605-339-6982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	12/01/2009

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Directions to “ BRITTANY POKALLUS ” Practice Location

Language	Start Address	Practice Location

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