Provider Demographics
NPI:1932400983
Name:CC'S PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CC'S PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:METTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, WCS
Authorized Official - Phone:701-751-0994
Mailing Address - Street 1:207 W FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5514
Mailing Address - Country:US
Mailing Address - Phone:701-751-1657
Mailing Address - Fax:701-751-1657
Practice Address - Street 1:207 W FRONT AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5514
Practice Address - Country:US
Practice Address - Phone:701-751-1657
Practice Address - Fax:701-751-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
ND1589261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1473521Medicaid