Organization
PERFORMANCE PHYSICAL THERAPY PROF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J TJADEN BS, ATC (PRACTICE MANAGER)
(605) 722-6880
Entity
Organization
Contact information
Practice address
215 E JACKSON BLVD, SUITE B, SPEARFISH, SD 57783-2176
(605) 722-6880
(605) 722-6889
Mailing address
215 E JACKSON BLVD, SUITE B, SPEARFISH, SD 57783-2176
(605) 722-6880
(605) 722-6889
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041171
BLUE CROSS BLUE SHIELD SD
SD
Enumeration date
01/31/2007
Last updated
04/06/2011
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