Provider Demographics
NPI:1629319231
Name:KANNEGIETER, ERIN ELIZABETH (PTA)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:KANNEGIETER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SOUTH 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252
Mailing Address - Country:US
Mailing Address - Phone:605-432-4556
Mailing Address - Fax:605-432-5725
Practice Address - Street 1:1103 SOUTH 2ND STREET
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252
Practice Address - Country:US
Practice Address - Phone:605-432-4556
Practice Address - Fax:605-432-5725
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant