Organization
AVERA GREGORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MCKENZIE MARIE RANDALL DPT, PT, ATC (PHYSICAL THERAPIST)
(605) 835-5190
Entity
Organization
Contact information
Practice address
400 PARK AVE, GREGORY, SD 57533-1302
(605) 835-5190
(605) 835-5479
Mailing address
400 PARK AVE, GREGORY, SD 57533-1302
(605) 835-5190
(605) 835-5479
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
1767
SD
Other
Enumeration date
05/11/2016
Last updated
05/11/2016
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