1992224331 NPI number — ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.

Table of content: (NPI 1992224331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992224331 NPI number — ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.
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:
1992224331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 5TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRECKENRIDGE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56520-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-641-7725
Provider Business Mailing Address Fax Number:
218-641-6625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 N TOWER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-998-2980
Provider Business Practice Location Address Fax Number:
218-998-2981
Provider Enumeration Date:
09/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KRAUSE-ROBERTS
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
PT, PRESIDENT, CEO
Authorized Official Telephone Number:
218-641-7725

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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