NPIMap

Organization Active NPI

Black Hills Pediatric Therapy, LLC

  • Physical Therapist
  • Rapid City, SD
National Provider Identifier
1487990248
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BLACK HILLS PEDIATRIC THERAPY, LLC
Practice address
505 Kansas City St.
Suite #3
Rapid City, SD 57701-3673
Phone
(605) 222-3773
Fax
(605) 791-0631
NPI assigned
Dec 26, 2012
Last updated
Jan 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Mr. Tim Wald, PT, DPTNPI 1376603092
Title
PT, DPT - Owner
Phone
(605) 222-3773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

505 Kansas City St.
Suite #3
Rapid City, SD 57701-3673

Mailing address

505 Kansas City St.
Suite #3
Rapid City, SD 57701-3673
Phone (605) 222-3773

Other names 1

  • Dakota Stretch Therapy Former legal business name

National Provider Directory

National Provider Directory

Locations

505 Kansas City St
Ste 1
Rapid City, SD 57701
Phone (605) 343-2800

505 Kansas City St
Ste 3
Rapid City, SD 57701
Phone (605) 222-7336

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1487990248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 KANSAS CITY ST.",
            "address_2": "SUITE #3",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577013673",
            "telephone_number": "605-222-3773",
            "fax_number": "605-791-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 KANSAS CITY ST.",
            "address_2": "SUITE #3",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577013673",
            "telephone_number": "605-222-3773",
            "fax_number": "605-791-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "WALD",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PT, DPT - OWNER",
        "authorized_official_telephone_number": "605-222-3773",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dakota Stretch Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.