Provider Demographics
NPI:1700112729
Name:MANKE, JULIE MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:MANKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0435
Mailing Address - Country:US
Mailing Address - Phone:605-842-7188
Mailing Address - Fax:605-842-7189
Practice Address - Street 1:825 E 8 TH STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2633
Practice Address - Country:US
Practice Address - Phone:605-842-7188
Practice Address - Fax:605-842-7189
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1700112729OtherSIOUX VALLEY HEALTH PLAN
NE10025389600Medicaid
SD5831260Medicaid
SD1700112729OtherAVERA
SD1700112729OtherWELLMARK
SD9288136OtherDAKOTA CARE
SD1700112729OtherSIOUX VALLEY HEALTH PLAN