Provider Demographics
NPI:1730371097
Name:STURGIS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:STURGIS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LYNASS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-720-2555
Mailing Address - Street 1:1530 JUNCTION AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2124
Mailing Address - Country:US
Mailing Address - Phone:605-720-2555
Mailing Address - Fax:605-720-2560
Practice Address - Street 1:1530 JUNCTION AVENUE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2124
Practice Address - Country:US
Practice Address - Phone:605-720-2555
Practice Address - Fax:605-720-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5831193Medicaid
SDS101849Medicare PIN