Healthcare Provider Details

I. General information

NPI: 1023956836
Provider Name (Legal Business Name): ACTIVE EDGE PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN ST SE STE 2
KILLDEER ND
58640
US

IV. Provider business mailing address

10859 7TH ST SW
KILLDEER ND
58640-9325
US

V. Phone/Fax

Practice location:
  • Phone: 701-696-6047
  • Fax: 701-940-7581
Mailing address:
  • Phone: 701-696-6047
  • Fax: 701-940-7581

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: REEANN LEE SADOWSKY
Title or Position: OWNER
Credential: DPT
Phone: 701-629-8980