Individual
STEVEN LEE VAN GENDEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1319 WEST HAVENS, MITCHELL, SD 57301
(605) 996-4778
(605) 996-3660
Mailing address
1319 WEST HAVENS, MITCHELL, SD 57301
(605) 996-4778
(605) 996-3660
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1158
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46778
SANFORD
SD
01
—
4994487
WELLMARK
—
05
—
5834960
—
SD
01
—
P00278969
MEDICARE RAILROAD
SD
01
—
PT1158
DAKOTACARE
SD
Enumeration date
03/10/2006
Last updated
11/16/2012
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