Provider Demographics
NPI:1740211267
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 1:606 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3121
Practice Address - Country:US
Practice Address - Phone:701-667-0745
Practice Address - Fax:701-667-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND225100000X, 225X00000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND650024893OtherPALMETTO GBA
ND1460162Medicaid
ND5397930001OtherDMERC CIGNA
ND54130Medicaid
ND5470001OtherBLUE SHIELD OF ND