Basic Information
| Provider Information | |||||||||
| NPI: | 1992905012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHINABARGER | ||||||||
| FirstName: | BOB | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3450 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577093450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057202400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 949 HARMON ST | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577852452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057202400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 07/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1212 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1212 | 01 | SD | SD LICENSE | OTHER |