Healthcare Provider Details

I. General information

NPI: 1932400983
Provider Name (Legal Business Name): CCS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W FRONT AVE
BISMARCK ND
58504-5514
US

IV. Provider business mailing address

207 W FRONT AVE
BISMARCK ND
58504-5514
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-1657
  • Fax: 701-751-1657
Mailing address:
  • Phone: 701-751-1657
  • Fax: 701-751-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1589
License Number StateND

VIII. Authorized Official

Name: MRS. APRIL J METTLER
Title or Position: OWNER/CEO
Credential: PT, WCS
Phone: 701-751-0994