Provider Demographics
NPI:1063497873
Name:WINNER PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:WINNER PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-842-7188
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0435
Mailing Address - Country:US
Mailing Address - Phone:605-842-7188
Mailing Address - Fax:605-842-7189
Practice Address - Street 1:825 E 8TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2633
Practice Address - Country:US
Practice Address - Phone:605-842-7188
Practice Address - Fax:605-842-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9191865OtherDAKOTA CARE
SD0008436OtherWELLMARK
NE10025389600Medicaid
SD9191865OtherDAKOTA CARE
SD4344540001Medicare NSC