Individual
BRYAN CLARK HAIVALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1440 N MAIN ST, SPEARFISH, SD 57783-1505
(605) 644-4000
Mailing address
PO BOX 3450, RAPID CITY, SD 57709
(605) 644-4000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
SD
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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