Basic Information
| Provider Information | |||||||||
| NPI: | 1679016562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TISHER | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | BLAIR | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 242 | ||||||||
| Address2: | |||||||||
| City: | LANGFORD | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574540242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015185521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1311 VANDER HORCK ST | ||||||||
| Address2: | |||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574302254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2016 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1879 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.