Organization
KLUCK THERAPY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM A MATNEY (CPC)
(866) 289-0801
Entity
Organization
Contact information
Practice address
810 SOUTH MAPLE ST, WATERTOWN, SD 57201
(605) 753-5400
(605) 753-5400
Mailing address
224 BRIAR CLIFF ST SW, POPLAR GROVE, IL 61065
(815) 765-0200
(815) 765-1920
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
69
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040135
BLUE CROSS BLUE SHIELD SD
SD
01
—
0069
DAKOTA CARE
SD
05
—
5832233
—
SD
Enumeration date
08/13/2006
Last updated
08/22/2020
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