Provider Demographics
NPI:1962816298
Name:CHILDREN'S THERAPY SERVICES
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:605-877-2550
Mailing Address - Street 1:1774 CENTRE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-4029
Mailing Address - Country:US
Mailing Address - Phone:605-716-2634
Mailing Address - Fax:
Practice Address - Street 1:1774 CENTRE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-4029
Practice Address - Country:US
Practice Address - Phone:605-716-2634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0628252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5834854Medicaid