Provider Demographics
NPI:1225059074
Name:TEAMWORK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TEAMWORK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER AND GENERAL PARNTER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIEKING
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:605-335-8326
Mailing Address - Street 1:5132 S CLIFF AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5437
Mailing Address - Country:US
Mailing Address - Phone:605-335-8326
Mailing Address - Fax:
Practice Address - Street 1:5132 S CLIFF AVE # 4
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-335-8326
Practice Address - Fax:605-373-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025088100Medicaid
SDS41952Medicare PIN