Provider Demographics
NPI:1720130115
Name:HOVDE, SANDRA II (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HOVDE
Suffix:II
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD20729OtherSVC HEALTHPLAN
SD4997989OtherBCBS OF SD
SD5831183Medicaid
SD14518OtherFIRST CHOICE OF THE MIDWE
SD20729OtherSVC HEALTHPLAN
SD42135Medicare ID - Type UnspecifiedMEDICARE NUMBER