Provider Demographics
NPI:1659014637
Name:BERENTSCHOT, BECKY (DPT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:BERENTSCHOT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51240-0124
Mailing Address - Country:US
Mailing Address - Phone:605-759-0908
Mailing Address - Fax:
Practice Address - Street 1:440 N HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-5800
Practice Address - Country:US
Practice Address - Phone:605-764-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist