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General NPI Number Information
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NPI Number | 1275243388
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Entity Type | Organization
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Legal Business Name | UP NORTH PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 608 EMILY AVE NW
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City | WARROAD
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State | MN
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Zip | 56763-2706
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Country | US
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Telephone | 218-242-4633
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | WARROAD
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State | MN
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Zip | 56763-0344
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Country | US
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Telephone | 218-242-4633
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Fax | 218-440-6880
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | BENJAMIN BLEESS
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Credential | DPT
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Telephone | 218-242-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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