Healthcare Provider Details

I. General information

NPI: 1891186722
Provider Name (Legal Business Name): CENTRAL DAKOTA PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 4TH ST N
CARRINGTON ND
58421-1217
US

IV. Provider business mailing address

800 4TH ST N PO BOX 461
CARRINGTON ND
58421-1217
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-7179
  • Fax: 701-652-1407
Mailing address:
  • Phone: 701-652-7179
  • Fax: 701-652-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0942
License Number StateND

VIII. Authorized Official

Name: KYLE E SMITH
Title or Position: PRESIDENT
Credential:
Phone: 701-652-7179