Healthcare Provider Details

I. General information

NPI: 1447200373
Provider Name (Legal Business Name): DSJ ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 N 11TH ST
BISMARCK ND
58503-0514
US

IV. Provider business mailing address

2945 N 11TH ST
BISMARCK ND
58503-0514
US

V. Phone/Fax

Practice location:
  • Phone: 701-258-7730
  • Fax: 701-258-7803
Mailing address:
  • Phone: 701-258-7730
  • Fax: 701-258-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number21,132,600
License Number StateND

VIII. Authorized Official

Name: DONNA ZASTOUPIL-HARTZE
Title or Position: PRESIDENT
Credential: PT
Phone: 701-258-7730