Healthcare Provider Details

I. General information

NPI: 1790355170
Provider Name (Legal Business Name): TKI ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 2ND ST SW STE B
GARRISON ND
58540
US

IV. Provider business mailing address

4991 14TH ST NW
GARRISON ND
58540-9651
US

V. Phone/Fax

Practice location:
  • Phone: 701-337-6488
  • Fax:
Mailing address:
  • Phone: 701-337-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
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: TAMMY IGLEHART
Title or Position: AO/OWNER
Credential: PT
Phone: 970-231-8558