Provider Demographics
NPI:1891186722
Name:CENTRAL DAKOTA PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:CENTRAL DAKOTA PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-652-7179
Mailing Address - Street 1:800 4TH ST N
Mailing Address - Street 2:PO BOX 461
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-1217
Mailing Address - Country:US
Mailing Address - Phone:701-652-7179
Mailing Address - Fax:701-652-1407
Practice Address - Street 1:800 4TH ST N
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-1217
Practice Address - Country:US
Practice Address - Phone:701-652-7179
Practice Address - Fax:701-652-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0942261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669681631OtherPERSONAL NPI