Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0322 | SD |
NPI | 1376732750 |
---|---|
Provider Name | Dana Lou Dykstra |
First Address | Pierre, SD 57501-4154 |
Second Address | Pierre, SD 57501-4154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 22/10/2007 |