Healthcare Provider Details

I. General information

NPI: 1275542268
Provider Name (Legal Business Name): SOUTHEAST THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 1ST AVENUE SOUTHWEST OMEGA CITY PLAZA
LAMOURE ND
58458-0686
US

IV. Provider business mailing address

PO BOX 368
OAKES ND
58474-0368
US

V. Phone/Fax

Practice location:
  • Phone: 701-883-5048
  • Fax: 701-883-5067
Mailing address:
  • Phone: 701-742-3267
  • Fax: 701-742-3201

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: THERESA KELLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-742-3267