Organization
THERATIME INC
Active
Organization
THERATIME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORY MICHAEL FABER (CEO/PRESIDENT)
(605) 339-1800
Entity
Organization
Contact information
Practice address
2115 S PENDAR LN, SIOUX FALLS, SD 57105-3944
(605) 339-1800
(605) 339-1239
Mailing address
2115 S PENDAR LN, SIOUX FALLS, SD 57105-3944
(605) 339-1800
(605) 339-1239
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
0295
SD
225XP0200X
Pediatric Occupational Therapist
0522
SD
235Z00000X
Speech-Language Pathologist
01100452
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5834750
—
SD
Enumeration date
09/20/2007
Last updated
09/20/2007
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