Healthcare Provider Details

I. General information

NPI: 1467462127
Provider Name (Legal Business Name): SCOTT JAKE THOMPSON PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 2ND AVE N STOP 9013
GRAND FORKS ND
58202-9013
US

IV. Provider business mailing address

725 HAMLINE ST STE 1200
GRAND FORKS ND
58203-2819
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-4845
  • Fax: 701-777-2536
Mailing address:
  • Phone: 701-777-6732
  • Fax: 701-777-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1477
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1477
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: