Healthcare Provider Details

I. General information

NPI: 1194021873
Provider Name (Legal Business Name): BIG STONE THERAPIES FARGO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 UNIVERSITY DR S STE 202
FARGO ND
58103-6050
US

IV. Provider business mailing address

500 CROSS ST
BIG STONE CITY SD
57216-8237
US

V. Phone/Fax

Practice location:
  • Phone: 701-478-0307
  • Fax: 701-478-0309
Mailing address:
  • Phone: 605-541-1140
  • Fax: 605-541-0109

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 Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE ACKERMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-541-1144