Provider Demographics
NPI:1417139890
Name:TLC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:TLC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:THEA
Authorized Official - Middle Name:LOY
Authorized Official - Last Name:PALLANSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-345-3710
Mailing Address - Street 1:1290 NORTH MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-1114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1290 NORTH MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274-1114
Practice Address - Country:US
Practice Address - Phone:605-345-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS6393OtherMEDICARE GROUP