Healthcare Provider Details

I. General information

NPI: 1659298016
Provider Name (Legal Business Name): ORIGIN PHYSICAL THERAPY AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 MAG SEVEN CT SW
BEMIDJI MN
56601-9804
US

IV. Provider business mailing address

554 WHISPERWOOD CT SW
BEMIDJI MN
56601-6136
US

V. Phone/Fax

Practice location:
  • Phone: 701-330-2558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIANA ISAKSON
Title or Position: OWNER
Credential:
Phone: 701-330-2558