Provider Demographics
NPI:1245304435
Name:HOVDES PHYSICAL THERAPY CLINIC
Entity type:Organization
Organization Name:HOVDES PHYSICAL THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-532-4212
Mailing Address - Street 1:312 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225-1405
Mailing Address - Country:US
Mailing Address - Phone:605-532-4212
Mailing Address - Fax:605-532-1343
Practice Address - Street 1:312 1ST AVE W
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:SD
Practice Address - Zip Code:57225-1405
Practice Address - Country:US
Practice Address - Phone:605-532-4212
Practice Address - Fax:605-532-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1194225100000X
SD0799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD110411OtherBERKLEY RISK ADMIN
SD22223OtherANN LARSON FIRST CHOICE
SD7079OtherANN LARSON AVERA
SD14518OtherSANDRA HOVDE FIRST CHOICE
SD20729OtherSANDRA HOVDE SIOUX VALLEY
SD14479OtherAMERICAN FAMILY PROVIDER
SD21256OtherANN LARSON SIOUX VALLEY
SD4997989OtherBCBS PROVIDER NUMBER
SD5831183Medicaid
SD5833542Medicaid
SDS42133Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
SD14518OtherSANDRA HOVDE FIRST CHOICE
SD4997989OtherBCBS PROVIDER NUMBER