Healthcare Provider Details

I. General information

NPI: 1215080437
Provider Name (Legal Business Name): UNIVERSITY OF NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 2ND AVE N STOP 9013 HYSLOP SPORTS CENTER ROOM 115
GRAND FORKS ND
58202-9013
US

IV. Provider business mailing address

2751 2ND AVE N STOP 9013 HYSLOP SPORTS CENTER ROOM 115
GRAND FORKS ND
58202-9013
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-6572
  • Fax: 701-777-2536
Mailing address:
  • Phone: 701-777-6572
  • Fax: 701-777-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATRINA LANDMAN
Title or Position: ADMIN
Credential:
Phone: 701-777-4845