Individual
MR. CHARLES E. MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPT
Contact information
Practice address
400 22ND AVE., BROOKINGS, SD 57006-2497
(605) 697-9500
(605) 697-6939
Mailing address
400 22ND AVE., BROOKINGS, SD 57006-2497
(605) 697-9500
(605) 697-6939
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0560
SD
2251H1200X
Hand Physical Therapist
Primary
0560
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5831322
—
SD
Enumeration date
05/17/2006
Last updated
03/20/2020
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