Provider Demographics
NPI:1689266728
Name:BEWELL PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BEWELL PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-361-4929
Mailing Address - Street 1:534 MAIN ST N UNIT B
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-4640
Mailing Address - Country:US
Mailing Address - Phone:701-361-4984
Mailing Address - Fax:
Practice Address - Street 1:534 MAIN ST N UNIT B
Practice Address - Street 2:
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-4640
Practice Address - Country:US
Practice Address - Phone:701-361-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-03-04
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
ND1184027534Medicaid