Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 539 | SD |
NPI | 1003216466 |
---|---|
Provider Name | Kristen Cross |
First Address | Spearfish, SD 57783-1505 |
Second Address | Spearfish, SD 57783-1505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2014 |
Last Update Date | 03/09/2014 |