Provider Demographics
NPI:1396419883
Name:OBRITSCH, MARANDA
Entity type:Individual
Prefix:
First Name:MARANDA
Middle Name:
Last Name:OBRITSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4660
Mailing Address - Country:US
Mailing Address - Phone:701-483-9400
Mailing Address - Fax:701-353-2076
Practice Address - Street 1:1401 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-1106
Practice Address - Country:US
Practice Address - Phone:605-845-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2424225100000X
ND2536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist