Provider Demographics
NPI:1922642016
Name:PRAIRIE PERFORMANCE PHYSICAL THERAPY & FITNESS, LLC
Entity Type:Organization
Organization Name:PRAIRIE PERFORMANCE PHYSICAL THERAPY & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-375-3039
Mailing Address - Street 1:12737 BROWN JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720-6002
Mailing Address - Country:US
Mailing Address - Phone:605-375-3039
Mailing Address - Fax:
Practice Address - Street 1:510 1ST ST E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720
Practice Address - Country:US
Practice Address - Phone:605-641-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy