Provider Demographics
NPI:1255929097
Name:PINE RIDGE THERAPY CENTER, LLC
Entity type:Organization
Organization Name:PINE RIDGE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROGNLIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L, CLT
Authorized Official - Phone:701-720-8857
Mailing Address - Street 1:798 56TH ST NE
Mailing Address - Street 2:
Mailing Address - City:TOWNER
Mailing Address - State:ND
Mailing Address - Zip Code:58788-9581
Mailing Address - Country:US
Mailing Address - Phone:701-720-8857
Mailing Address - Fax:
Practice Address - Street 1:2 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:TOWNER
Practice Address - State:ND
Practice Address - Zip Code:58788-7751
Practice Address - Country:US
Practice Address - Phone:701-720-8857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty