Provider Demographics
NPI:1578155461
Name:HAI, DERIK JAMES (MASSAGE THERAPISTS)
Entity Type:Individual
Prefix:
First Name:DERIK
Middle Name:JAMES
Last Name:HAI
Suffix:
Gender:M
Credentials:MASSAGE THERAPISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8585
Mailing Address - Country:US
Mailing Address - Phone:605-334-6656
Mailing Address - Fax:605-271-7616
Practice Address - Street 1:6705 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8585
Practice Address - Country:US
Practice Address - Phone:605-334-6656
Practice Address - Fax:605-271-7616
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist