Physiolife 605 PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PHYSIOLIFE 605 PLLC

Practice address

220 S Cliff Ave Ste 102
Harrisburg, SD 57032-2485

Phone

(605) 770-7331

NPI assigned

Apr 25, 2023

Last updated

Aug 22, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trever Wagner, PT, DPT, ATCNPI 1649629080

Title

Owner

Phone

(605) 767-1601

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Trever Wagner, PT, DPT

  • Physical Therapist
  • Rapid City, SD
  • NPI 1649629080
  Medicare reassignment Care Compare group NPD Authorized official
• Austin Ryan, PT

  • Physical Therapist
  • Harrisburg, SD
  • NPI 1164399358
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1396433629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 S CLIFF AVE STE 102",
            "city": "HARRISBURG",
            "state": "SD",
            "postal_code": "570322485",
            "telephone_number": "605-767-1601",
            "fax_number": "605-767-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S CLIFF AVE STE 102",
            "city": "HARRISBURG",
            "state": "SD",
            "postal_code": "570322485",
            "telephone_number": "605-770-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOLIFE 605 PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-25",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "TREVER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-767-1601",
        "authorized_official_credential": "PT, DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Ranee McCollister, MA, CCC-SLP
• Darin John Naatjes
• Lauren A O'Brien, MD
• Nathan Allen Joseph Olson, EMT
• Kayla Joy Orton
• Gary Popkes
• Prairie Rehabilitation Services, Inc
• Pumping Boutique
• Alanna Mae Ragle
• Sean Rasmusson

• Physical Therapy Clinic/Center in Harrisburg, SD
• Providers in Harrisburg, SD by specialty
• Physical Therapy Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.