Provider Demographics
NPI:1376087676
Name:ACHIEVE THERAPY
Entity Type:Organization
Organization Name:ACHIEVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC PTA
Authorized Official - Phone:701-746-8374
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58208-2938
Mailing Address - Country:US
Mailing Address - Phone:701-746-6694
Mailing Address - Fax:701-746-6894
Practice Address - Street 1:2424 32ND AVE S
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6545
Practice Address - Country:US
Practice Address - Phone:701-746-8374
Practice Address - Fax:701-780-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty