Healthcare Provider Details

I. General information

NPI: 1134780349
Provider Name (Legal Business Name): EMBRACE THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4342 15TH AVE S STE 105
FARGO ND
58103-1125
US

IV. Provider business mailing address

4342 15TH AVE S STE 105
FARGO ND
58103-1125
US

V. Phone/Fax

Practice location:
  • Phone: 701-936-9495
  • Fax: 952-222-1994
Mailing address:
  • Phone: 701-936-9495
  • Fax: 952-222-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEG VIELE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 701-951-9029