Provider Demographics
NPI:1588797922
Name:DAKOTA PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:DAKOTA PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-667-0745
Mailing Address - Street 1:606 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3121
Mailing Address - Country:US
Mailing Address - Phone:701-667-0745
Mailing Address - Fax:701-667-0707
Practice Address - Street 1:1000 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0913
Practice Address - Country:US
Practice Address - Phone:701-355-1294
Practice Address - Fax:701-323-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND208100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND547001OtherND BLUE CROSS BLUE SHIELD
ND1460162Medicaid
NDDF2152OtherPALMETTO GBA
ND54130Medicaid
ND54130Medicaid
ND547001OtherND BLUE CROSS BLUE SHIELD