Provider Demographics
NPI:1821049057
Name:CREEL, JANA SUE (PT,ACT)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:SUE
Last Name:CREEL
Suffix:
Gender:F
Credentials:PT,ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S. MINNESOTA AVE.
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1722
Mailing Address - Country:US
Mailing Address - Phone:605-335-7723
Mailing Address - Fax:605-339-3778
Practice Address - Street 1:1700 S. MINNESOTA AVE.
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1722
Practice Address - Country:US
Practice Address - Phone:605-335-7723
Practice Address - Fax:605-339-3778
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5830350Medicaid