Provider Demographics
NPI:1396805222
Name:FLEXIBIL OT INC
Entity type:Organization
Organization Name:FLEXIBIL OT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:605-484-9759
Mailing Address - Street 1:4824 ENCHANTED PINES DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9235
Mailing Address - Country:US
Mailing Address - Phone:605-484-9759
Mailing Address - Fax:605-721-5940
Practice Address - Street 1:4824 ENCHANTED PINES DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9235
Practice Address - Country:US
Practice Address - Phone:605-484-9759
Practice Address - Fax:605-721-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0597261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation