Provider Demographics
NPI:1811205305
Name:HILDEBRANDT, CHRISTINE DAWN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DAWN
Last Name:HILDEBRANDT
Suffix:
Gender:F
Credentials:
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 1284
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7284
Mailing Address - Country:US
Mailing Address - Phone:605-995-6044
Mailing Address - Fax:605-995-6044
Practice Address - Street 1:501 W HAVENS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4366
Practice Address - Country:US
Practice Address - Phone:605-995-6044
Practice Address - Fax:605-995-6044
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist