Provider Demographics
NPI:1366568743
Name:HIGH PLAINS PHYSICAL THERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:HIGH PLAINS PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:605-348-9530
Mailing Address - Street 1:18 E KANSAS CITY ST #101
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2971
Mailing Address - Country:US
Mailing Address - Phone:605-348-9530
Mailing Address - Fax:605-737-0874
Practice Address - Street 1:18 E KANSAS CITY ST #101
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2971
Practice Address - Country:US
Practice Address - Phone:605-348-9530
Practice Address - Fax:605-737-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD53001EUT001261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6049860001Medicare NSC
SD6049860001Medicare NSC
SDS7647OtherLEGACY NUMBER