Healthcare Provider Details

I. General information

NPI: 1427943760
Provider Name (Legal Business Name): MINDA MARIE BUCHOLZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY DR S
FARGO ND
58103-4940
US

IV. Provider business mailing address

1176 JILL DR W
WEST FARGO ND
58078-2951
US

V. Phone/Fax

Practice location:
  • Phone: 701-417-4247
  • Fax:
Mailing address:
  • Phone: 701-799-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: