Provider Demographics
NPI:1740398833
Name:RAPID CITY PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:RAPID CITY PHYSICAL THERAPY, INC
Other - Org Name:THE PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATON VARCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-721-5950
Mailing Address - Street 1:1110 W OMAHA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8097
Mailing Address - Country:US
Mailing Address - Phone:605-721-5950
Mailing Address - Fax:605-721-5940
Practice Address - Street 1:1110 W OMAHA ST STE 3
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8097
Practice Address - Country:US
Practice Address - Phone:605-721-5950
Practice Address - Fax:605-721-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDB047346261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD41741Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER