1841753134 NPI number — NORTHWEST THERAPY SERVICES, LLC.

Table of content: (NPI 1841753134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841753134 NPI number — NORTHWEST THERAPY SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST THERAPY SERVICES, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841753134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 736
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAY
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-690-6705
Provider Business Mailing Address Fax Number:
701-568-8256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 RAILROAD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-690-6705
Provider Business Practice Location Address Fax Number:
701-568-8256
Provider Enumeration Date:
04/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BARMAN
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official Telephone Number:
701-568-8255

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1851781082 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851781082 . This is a "SANFORD, UHC, MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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