Provider Demographics
NPI:1861515090
Name:PHYSICAL THERAPY SPECIALISTS PC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMINET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-234-8760
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1533
Mailing Address - Country:US
Mailing Address - Phone:605-242-5016
Mailing Address - Fax:605-242-5018
Practice Address - Street 1:317 DAKOTA DUNES BLVD
Practice Address - Street 2:#D
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5341
Practice Address - Country:US
Practice Address - Phone:605-242-5016
Practice Address - Fax:605-242-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD=========OtherFEDERAL TAD ID NUMBER
SD1865155090Medicare UPIN