Basic Information
| Provider Information | |||||||||
| NPI: | 1508176025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATZLAFF | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SWANSON | ||||||||
| OtherFirstName: | AMBER | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11026 422ND AVE | ||||||||
| Address2: | |||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574305608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1131 VANDER HORCK W HWY 10 | ||||||||
| Address2: | |||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1639 | ND | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251G0304X | 1510 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.