Provider Demographics
NPI:1407919210
Name:ACHIEVE THERAPY LLC
Entity Type:Organization
Organization Name:ACHIEVE THERAPY LLC
Other - Org Name:ACHIEVE THERAPY OF PARK RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OFFICE MANAGER
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 1:1425 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4039
Mailing Address - Country:US
Mailing Address - Phone:701-746-8374
Mailing Address - Fax:701-780-0885
Practice Address - Street 1:110 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1415
Practice Address - Country:US
Practice Address - Phone:218-237-3052
Practice Address - Fax:218-237-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN370068100Medicaid
MN183H5SEOtherBCBS MN
MN64-07686OtherMEDICA
MNC04550Medicare PIN