MEDICARE: PRAIRIE REHABILITATION SERVICES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790498962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAIRIE REHABILITATION SERVICES, INC

Provider Business Mailing Address
First Line	:	1720 S CLIFF AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2129
Country	:	US
Telephone Number	:	605-339-0729
Fax Number	:	605-335-2746

Provider Business Practice Location Address
First Line	:	412 FOX LAKE AVENUE
Second Line	:
City	:	SHERBURN
State	:	MN
Zip	:	56171
Country	:	US
Telephone Number	:	507-764-2933
Fax Number	:	507-764-2301

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LEE S GLASOE
Credential	:
Telephone Number	:	605-334-5630

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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Directions to “PRAIRIE REHABILITATION SERVICES, INC ” Practice Location

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