Healthcare Provider Details

I. General information

NPI: 1942486113
Provider Name (Legal Business Name): THIELGES THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAIN STREET SE
LAMOURE ND
58458-0007
US

IV. Provider business mailing address

7274 108TH AVE SE
LAMOURE ND
58458-9409
US

V. Phone/Fax

Practice location:
  • Phone: 701-883-5456
  • Fax:
Mailing address:
  • Phone: 701-883-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTA THIELGES
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-883-5464