Provider Demographics
NPI:1073649901
Name:DPT INC
Entity Type:Organization
Organization Name:DPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:605-996-4778
Mailing Address - Street 1:1319 W HAVENS ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4116
Mailing Address - Country:US
Mailing Address - Phone:605-996-4778
Mailing Address - Fax:
Practice Address - Street 1:1319 W HAVENS ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4116
Practice Address - Country:US
Practice Address - Phone:605-996-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9213206OtherDAKOTA CARE
SD4998325OtherBLUE CROSS BLUE SHIELD
SD5834960Medicaid
SDP00278968OtherMEDICARE RAILROAD
SDDC0567Medicare PIN
SDS41281Medicare PIN