Healthcare Provider Details

I. General information

NPI: 1346370640
Provider Name (Legal Business Name): ACHIEVE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 DEMERS AVE
GRAND FORKS ND
58201-4040
US

IV. Provider business mailing address

3035 DEMERS AVE
GRAND FORKS ND
58201-4040
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-6694
  • Fax: 701-746-6894
Mailing address:
  • Phone: 701-746-6694
  • Fax: 701-746-6894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE D ELLIS
Title or Position: OWNER
Credential: ATC, PTA
Phone: 701-746-8374