Healthcare Provider Details

I. General information

NPI: 1255148615
Provider Name (Legal Business Name): OPTIMUM THERAPIES OF NORTH DAKOTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4524 MEMORIAL HWY UNIT 107
MANDAN ND
58554-4771
US

IV. Provider business mailing address

1040 CANADA AVE STE 1
BISMARCK ND
58503-1813
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-3064
  • Fax: 701-751-2265
Mailing address:
  • Phone: 715-855-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUE M DRAKE
Title or Position: BILLING
Credential:
Phone: 715-855-0430