Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1694 | SD |
NPI | 1003249012 |
---|---|
Provider Name | Ryan James Mentele |
First Address | Mitchell, SD 57301-4116 |
Second Address | Mitchell, SD 57301-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2013 |
Last Update Date | 13/08/2013 |