Healthcare Provider Details

I. General information

NPI: 1588175061
Provider Name (Legal Business Name): TOTAL BALANCE PHYSICAL THERAPY AND FITNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 BROADWAY N STE 106
FARGO ND
58102-2622
US

IV. Provider business mailing address

1461 BROADWAY N STE 106
FARGO ND
58102-2622
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-6037
  • Fax:
Mailing address:
  • Phone: 701-293-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1970
License Number StateND

VIII. Authorized Official

Name: DR. DANIEL WILLIAM JOHNSON
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 701-293-6037