Provider Demographics
NPI:1659855799
Name:KINGSBURY, TARKENTON (DPT)
Entity Type:Individual
Prefix:
First Name:TARKENTON
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:M
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 39
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:SD
Mailing Address - Zip Code:57349-0039
Mailing Address - Country:US
Mailing Address - Phone:605-772-2131
Mailing Address - Fax:
Practice Address - Street 1:131 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:SD
Practice Address - Zip Code:57349-9064
Practice Address - Country:US
Practice Address - Phone:605-772-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist