Provider Demographics
NPI:1205058120
Name:FEESER, JUSTIN G (RPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:G
Last Name:FEESER
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:SPEARFISH REGIONAL HOSPITAL
Mailing Address - Street 2:PO BOX 3450
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709
Mailing Address - Country:US
Mailing Address - Phone:605-644-4000
Mailing Address - Fax:
Practice Address - Street 1:1440 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783
Practice Address - Country:US
Practice Address - Phone:605-644-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0785OtherLICENSE