| Root Function Wellness Pllc | |
|
2320 9th Ave Se Watertown SD 57201-7112 | |
| (605) 753-0920 | |
| Not Available |
| Full Name | Root Function Wellness Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2320 9th Ave Se, Watertown, South Dakota |
| Authorized Official Name and Position | Amy Wagoner (MEMBER) |
| Authorized Official Contact | 6058800679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Root Function Wellness Pllc 6554 9th Ave Sw Watertown SD 57201-7099 Ph: (605) 880-0679 | Root Function Wellness Pllc 2320 9th Ave Se Watertown SD 57201-7112 Ph: (605) 753-0920 |
| NPI Number | 1437629128 |
|---|---|
| Provider Enumeration Date | 11/26/2018 |
| Last Update Date | 11/26/2018 |
| Medicare PECOS PAC ID | 6406193614 |
|---|---|
| Medicare Enrollment ID | O20190125002213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437629128 | NPI | - | NPPES |
| 1376554568 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Amy L Wagoner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376554568 PECOS PAC ID: 6406939321 Enrollment ID: I20121128000532 |
| Provider Name | Lori Anderson Steinley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366481186 PECOS PAC ID: 8921906744 Enrollment ID: I20220511002045 |
| Provider Name | Maurie S Steinley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1578594792 PECOS PAC ID: 0547268153 Enrollment ID: I20220517002926 |
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