Provider Demographics
NPI:1295968220
Name:HARSTAD, CHARITY ANNE (PT)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANNE
Last Name:HARSTAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 WEST INTERSTATE AVENUE
Mailing Address - Street 2:SUITE 12 BLDG 3
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-223-8717
Mailing Address - Fax:701-255-3957
Practice Address - Street 1:911 WEST INTERSTATE AVENUE
Practice Address - Street 2:SUITE 12 BLDG 3
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-223-8717
Practice Address - Fax:701-255-3957
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist