Provider Demographics
NPI:1114453339
Name:HIGH PLAINS PHYSICAL THERAPY II LLC
Entity Type:Organization
Organization Name:HIGH PLAINS PHYSICAL THERAPY II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-348-9530
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-0474
Mailing Address - Country:US
Mailing Address - Phone:605-348-9530
Mailing Address - Fax:605-737-0874
Practice Address - Street 1:5610 PEACEFUL PINES RD #4
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:SD
Practice Address - Zip Code:57718-9253
Practice Address - Country:US
Practice Address - Phone:605-348-9530
Practice Address - Fax:605-737-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy