Provider Demographics
NPI:1386036119
Name:BETINA K BASSO
Entity Type:Organization
Organization Name:BETINA K BASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:BETINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASSO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-415-0033
Mailing Address - Street 1:13621 NECK YOKE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7324
Mailing Address - Country:US
Mailing Address - Phone:605-415-0033
Mailing Address - Fax:
Practice Address - Street 1:13621 NECK YOKE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-7324
Practice Address - Country:US
Practice Address - Phone:605-415-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0963261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy