Provider Demographics
NPI:1851964423
Name:ACTIVATE PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:ACTIVATE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:ACTIVATE PT
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STUDSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:701-532-2270
Mailing Address - Street 1:5675 26TH AVE S STE 152
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8975
Mailing Address - Country:US
Mailing Address - Phone:701-532-2270
Mailing Address - Fax:701-532-0507
Practice Address - Street 1:5675 26TH AVE S STE 152
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8975
Practice Address - Country:US
Practice Address - Phone:701-371-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy