Provider Demographics
NPI:1336106855
Name:RAHDER, STEPHANIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:RAHDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1552 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-4022
Mailing Address - Country:US
Mailing Address - Phone:605-352-9498
Mailing Address - Fax:605-352-3452
Practice Address - Street 1:1552 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4022
Practice Address - Country:US
Practice Address - Phone:605-352-9498
Practice Address - Fax:605-352-3452
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00418138OtherRAILROAD MEDICARE
SD5834493Medicaid
SDS101840Medicare PIN
6046760001Medicare NSC