Provider Demographics
NPI:1215112438
Name:LITTLE MIRACLES, PT, INC
Entity type:Organization
Organization Name:LITTLE MIRACLES, PT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:605-343-2555
Mailing Address - Street 1:717 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9584
Mailing Address - Country:US
Mailing Address - Phone:605-343-2555
Mailing Address - Fax:605-343-2563
Practice Address - Street 1:717 AUBURN DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9584
Practice Address - Country:US
Practice Address - Phone:605-343-2555
Practice Address - Fax:605-343-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0593251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1134286206OtherNPI CONNECTED TO MY NAME
SD5833610Medicaid