Provider Demographics
NPI:1942893177
Name:YELLOW ROSE DIGITAL THERAPY
Entity Type:Organization
Organization Name:YELLOW ROSE DIGITAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-361-4984
Mailing Address - Street 1:534 N MAIN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047
Mailing Address - Country:US
Mailing Address - Phone:701-361-4984
Mailing Address - Fax:701-203-3958
Practice Address - Street 1:534 N MAIN ST
Practice Address - Street 2:UNIT B
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047
Practice Address - Country:US
Practice Address - Phone:701-361-4984
Practice Address - Fax:701-203-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty