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NPI Code Detail

MEDICARE: KIMBERLY S. COCKRUM MSPT

MEDICARE: KIMBERLY S. COCKRUM MSPT
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 Therapist0663SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14995254OTHERSDWELLMARK BC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922006303
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY S. COCKRUM MSPT
Provider Business Mailing Address
First Line : 520 N CANYON ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2320
Country : US
Telephone Number : 605-642-7996
Fax Number : 605-642-5955
Provider Business Practice Location Address
First Line : 520 N CANYON ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2320
Country : US
Telephone Number : 605-642-7996
Fax Number : 605-642-5955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 01/30/2012

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1275727745 — PEGGY A SMITH B.P.T.
Practice Location Address:
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1629376249 — MRS. TARA DOMKOWSKI P.T., D.P.T.
Practice Location Address:
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1760891923 — JENS K MATSON PT. DPT, OCS, CMPT
Practice Location Address:
520 N CANYON ST
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Practice Fax: 605-642-5955

Directions to “ KIMBERLY S. COCKRUM MSPT” Practice Location

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