Provider Demographics
NPI:1992715197
Name:ORTHOPEDIC PHYSICAL THERAPY CENTER LTD
Entity type:Organization
Organization Name:ORTHOPEDIC PHYSICAL THERAPY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-725-9900
Mailing Address - Street 1:6 NORTH ROOSEVELT STREET
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-725-9900
Mailing Address - Fax:605-725-9902
Practice Address - Street 1:6 NORTH ROOSEVELT STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-725-9900
Practice Address - Fax:605-725-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0435225100000X
ND891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994784OtherBCBS
SD5830333Medicaid
SD9229263OtherDAKOTA CARE
SD9229263OtherDAKOTA CARE