Provider Demographics
NPI:1942486113
Name:THIELGES THERAPY INC
Entity Type:Organization
Organization Name:THIELGES THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-883-5464
Mailing Address - Street 1:7274 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-9409
Mailing Address - Country:US
Mailing Address - Phone:701-883-5464
Mailing Address - Fax:
Practice Address - Street 1:119 MAIN STREET SE
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-0007
Practice Address - Country:US
Practice Address - Phone:701-883-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
28815OtherBLUESHIELD
NDN713344Medicare PIN