Provider Demographics
NPI:1669696795
Name:VOLLAN-KERBER, ANNETTE DIANNE (PT, MS, PCS)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:DIANNE
Last Name:VOLLAN-KERBER
Suffix:
Gender:F
Credentials:PT, MS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 N MARTINDALE RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-0117
Mailing Address - Country:US
Mailing Address - Phone:605-331-5621
Mailing Address - Fax:
Practice Address - Street 1:1100 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6325
Practice Address - Country:US
Practice Address - Phone:605-782-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD21376OtherSIOUX VALLEY HEALTH PLAN