Healthcare Provider Details

I. General information

NPI: 1326776782
Provider Name (Legal Business Name): NICHOLAS DEAN HOVDE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 CENTRAL AVE NW
EAST GRAND FORKS MN
56721-1617
US

IV. Provider business mailing address

PO BOX 12938
GRAND FORKS ND
58208-2938
US

V. Phone/Fax

Practice location:
  • Phone: 218-773-3388
  • Fax: 218-773-6611
Mailing address:
  • Phone: 701-746-8374
  • Fax: 701-780-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12812
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: