Healthcare Provider Details

I. General information

NPI: 1447174990
Provider Name (Legal Business Name): EVAN HENKE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1251 1ST ST S
DICKINSON ND
58601-4663
US

IV. Provider business mailing address

5097 99TH AVE SW
LEFOR ND
58641-9211
US

V. Phone/Fax

Practice location:
  • Phone: 303-917-5496
  • Fax: 701-390-1366
Mailing address:
  • Phone: 303-917-5496
  • Fax: 701-390-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2945
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2945
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: