Provider Demographics
NPI:1285707414
Name:BICH, JONI (PT)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:
Last Name:BICH
Suffix:
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-0097
Mailing Address - Country:US
Mailing Address - Phone:605-234-1287
Mailing Address - Fax:
Practice Address - Street 1:200 PAUL GUST RD
Practice Address - Street 2:SUITE 109
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-1031
Practice Address - Country:US
Practice Address - Phone:605-234-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4996059OtherBC BS
SD5834150Medicaid
SD4996059OtherBC BS