Healthcare Provider Details

I. General information

NPI: 1710931431
Provider Name (Legal Business Name): MATTHEW GARY ASKIM PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 FIRST AVE. E.
ROSHOLT SD
57260-0108
US

IV. Provider business mailing address

2231 60TH AVE S
FARGO ND
58104-7602
US

V. Phone/Fax

Practice location:
  • Phone: 605-537-4272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number#1232
License Number StateND

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: