Provider Demographics
NPI:1669439188
Name:ANSHUTZ, FORREST (PT)
Entity Type:Individual
Prefix:MR
First Name:FORREST
Middle Name:
Last Name:ANSHUTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1159
Mailing Address - Country:US
Mailing Address - Phone:605-692-8848
Mailing Address - Fax:605-692-8849
Practice Address - Street 1:302 W 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1159
Practice Address - Country:US
Practice Address - Phone:605-692-8848
Practice Address - Fax:605-692-8849
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00603949OtherRAILROAD MEDICARE
SD5830704Medicaid
SDP00603949OtherRAILROAD MEDICARE
SD5830704Medicaid