Provider Demographics
NPI:1821242967
Name:JOEBGEN, MIKE E (RPT)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:E
Last Name:JOEBGEN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5884 LEGACY LN
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-6763
Mailing Address - Country:US
Mailing Address - Phone:605-685-4847
Mailing Address - Fax:
Practice Address - Street 1:5884 LEGACY LN
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-6763
Practice Address - Country:US
Practice Address - Phone:605-685-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD08512251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics