Provider Demographics
NPI:1144216458
Name:TEVELDAL, BRETT D (PT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:D
Last Name:TEVELDAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1720 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2129
Practice Address - Country:US
Practice Address - Phone:605-334-5630
Practice Address - Fax:605-332-5327
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5833143Medicaid
SD27416OtherSIOUX VALLEY HEALTH PLAN
SD4994832OtherBLUE CROSS BLUE SHIELD SD
SD64-03937OtherMEDICA
SD64-04055OtherMEDICA
SD361J8TEOtherBLUE CROSS BLUE SHIELD MN
SD5833144Medicaid
SD64-03936OtherMEDICA
SD1042.1OtherDAKOTACARE
SD1810856OtherARAZ
SD4996126OtherBLUE CROSS BLUE SHIELD SD
SD64-05333OtherMEDICA
SD4996418OtherBLUE CROSS BLUE SHIELD SD
SD5833142Medicaid
SD5833140Medicaid