Individual
NICCOLE J MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
901 4TH ST NW, WATERTOWN, SD 57201-1558
(605) 886-8471
(605) 886-9317
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
(605) 328-6512
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1225
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5834040
—
SD
Enumeration date
10/18/2005
Last updated
11/05/2013
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