Provider Demographics
NPI:1871657254
Name:TORGRUDE, BRIENNE (PT)
Entity Type:Individual
Prefix:
First Name:BRIENNE
Middle Name:
Last Name:TORGRUDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 DERDALL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2851
Mailing Address - Country:US
Mailing Address - Phone:605-697-5145
Mailing Address - Fax:
Practice Address - Street 1:2218 DERDALL DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2851
Practice Address - Country:US
Practice Address - Phone:605-697-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9263537OtherDAKOTACARE
SD9178925OtherDAKOTACARE
SDS102570Medicare PIN
SD1356510812Medicare PIN
SD9178925OtherDAKOTACARE