Provider Demographics
NPI:1265960918
Name:TWEED, DAKOTA CLAREN (PT)
Entity type:Individual
Prefix:MRS
First Name:DAKOTA
Middle Name:CLAREN
Last Name:TWEED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DAKOTA
Other - Middle Name:CLAREN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:701 3RD ST NW
Mailing Address - Street 2:PO BOX 8000
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58402
Mailing Address - Country:US
Mailing Address - Phone:701-751-6336
Mailing Address - Fax:
Practice Address - Street 1:701 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-751-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1471299Medicaid