Provider Demographics
NPI:1447200373
Name:DSJ ENTERPRISES, LLC
Entity Type:Organization
Organization Name:DSJ ENTERPRISES, LLC
Other - Org Name:AIM PHYSICAL THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZASTOUPIL-HARTZE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-258-7730
Mailing Address - Street 1:2945 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0514
Mailing Address - Country:US
Mailing Address - Phone:701-258-7730
Mailing Address - Fax:701-258-7803
Practice Address - Street 1:2945 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0514
Practice Address - Country:US
Practice Address - Phone:701-258-7730
Practice Address - Fax:701-258-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21,132,600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50972Medicaid
ND711621Medicare ID - Type Unspecified