Provider Demographics
NPI:1720240278
Name:RAINBOTH, BRANDIE LYNN (DPT)
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:LYNN
Last Name:RAINBOTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:BRANDIE
Other - Middle Name:LYNN
Other - Last Name:SALVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:305 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2334
Mailing Address - Country:US
Mailing Address - Phone:605-559-0381
Mailing Address - Fax:
Practice Address - Street 1:305 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2334
Practice Address - Country:US
Practice Address - Phone:605-559-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1720240278Medicaid
SD1720240278OtherWELLMARK BCBS
WY1720240278Medicaid
SD1720240278Medicaid