Individual
TERESA STINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
224 ELK ST, RAPID CITY, SD 57701-7359
(605) 755-7710
Mailing address
542 LINCOLN DR, ELLSWORTH AFB, SD 57706-6100
(217) 556-6545
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0513
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0516
SDBMOE PTA LICENSE
SD
Enumeration date
01/09/2018
Last updated
01/09/2018
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