| NPI | 1902892409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE S GLASOE Administrator 605-334-5630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MN 022510002) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SD 0225410001) | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2009-08-17 |