Organization
SUNDOG REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH PETTYJOHN DPT (SOLE MEMBER)
(605) 787-2719
Entity
Organization
Contact information
Practice address
3064 COVINGTON ST, SUITE 104, RAPID CITY, SD 57703-7207
(605) 787-2719
(605) 718-4452
Mailing address
3064 COVINGTON ST, SUITE 104, RAPID CITY, SD 57703-7207
(605) 787-2719
(605) 718-4452
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1487
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S105011
MEDICARE PTAN
—
Enumeration date
04/22/2011
Last updated
11/25/2015
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