Individual
TILE PAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2415 MOUNT RUSHMORE RD STE B, RAPID CITY, SD 57701-5102
(605) 545-8543
Mailing address
2415 MOUNT RUSHMORE RD STE B, RAPID CITY, SD 57701-5102
(605) 545-8543
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT11775
SD
Other
Enumeration date
04/27/2021
Last updated
04/27/2021
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