Provider Demographics
NPI:1225215338
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRAUSE-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:218-641-7725
Mailing Address - Street 1:430 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1426
Mailing Address - Country:US
Mailing Address - Phone:218-641-7725
Mailing Address - Fax:218-641-6625
Practice Address - Street 1:112 5TH ST SW
Practice Address - Street 2:
Practice Address - City:HANKINSON
Practice Address - State:ND
Practice Address - Zip Code:58041-4417
Practice Address - Country:US
Practice Address - Phone:701-242-7323
Practice Address - Fax:701-242-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1180225100000X
MN6521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26722OtherND BCBS
MN03N04OROtherMN BCBS
MN64-06755OtherMEDICA
NDDD3739OtherRAILROAD MEDICARE
ND54541Medicaid
NDDD3739OtherRAILROAD MEDICARE