Provider Demographics
NPI:1063558450
Name:BACKOUS, THERESA ZENS (ATC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ZENS
Last Name:BACKOUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:ZENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1735 S ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7821
Mailing Address - Country:US
Mailing Address - Phone:605-229-1585
Mailing Address - Fax:
Practice Address - Street 1:305 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4527
Practice Address - Country:US
Practice Address - Phone:605-622-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0040282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital