Provider Demographics
NPI:1992224331
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, ATC
Authorized Official - Phone:218-641-7725
Mailing Address - Street 1:430 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1426
Mailing Address - Country:US
Mailing Address - Phone:218-641-7725
Mailing Address - Fax:218-641-6625
Practice Address - Street 1:322 N TOWER RD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1015
Practice Address - Country:US
Practice Address - Phone:218-998-2980
Practice Address - Fax:218-998-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty