Individual
MYRON P SORESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.P.T.
Contact information
Practice address
4141 5TH ST, RAPID CITY, SD 57701-6021
(605) 399-9565
(605) 399-9584
Mailing address
4141 5TH ST, RAPID CITY, SD 57701-6021
(605) 399-9565
(605) 399-9584
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0562
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0562
DAKOTACARE
SD
01
—
22924
SANFORD HEALTH
SD
01
—
4998878
WELLMARK
SD
05
—
5831210
—
SD
Enumeration date
03/22/2006
Last updated
12/03/2011
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