ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC (NPI# 1811923535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811923535 |
| Entity Type | Organization |
| Organization Name | ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC |
| Practice Address |
430 5th St N Breckenridge MN 56520-1426 |
| Practice Telephone | 2186417725 |
| Practice Fax Number | 2186416625 |
| Mailing Telephone | 2186417725 |
| Mailing Fax Number | 2186416625 |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2018-01-10 |
| Authorized Official Name | MRS. SHAWN MARIE KRAUSE ROBERTS (PRESIDENT) |
| Authorized Official Telephone | 2186417725 |
| Authorized Official Credential | PT/ATC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | 6521 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 225100000X | Physical Therapist | 1180 | ND | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | RR MEDICARE | DD3739 | 01 |
| MN | MN BCBS | 057K80R | 01 |
| MN | MN BCBS FOR OT'S | 121G4OR | 01 |
| MN | HEALTH PARTNERS | 96570 | 01 |
| MN | US DEPT OF LABOR | 101592300 | 01 |
| MN | 148478000 | 05 | |
| MN | PREFERRED ONE | 1041486 | 01 |
| ND | 1458152 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063938447 | Orthopedic & Sports Physical Therapy, Inc | Physical Therapist | 5475 51st Ave S, Fargo, ND 58104-6014 | 2017-08-17 |
| Street Address |
430 5TH ST N |
| City | BRECKENRIDGE |
| State | MN |
| Zip Code | 56520-1426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609829621 | Tera Deeann Paulson | Physical Therapist | 430 5th St N, Breckenridge, MN 56520-1426 | 2006-05-19 |
| 1295369122 | Kaylen Podjaski | Physical Therapist | 430 5th St N, Breckenridge, MN 56520-1426 | 2020-03-01 |
| 1528606258 | Kimberly Kay Ceroll | Physical Therapy Assistant | 430 5th St N, Breckenridge, MN 56520-1426 | 2019-12-12 |
| 1447737473 | Victoria Rose Wisnewski | Massage Therapist | 430 5th St N, Breckenridge, MN 56520-1426 | 2018-07-23 |
| 1063913259 | Gwen Humann | Physical Therapist | 430 5th St N, Breckenridge, MN 56520-1426 | 2018-02-23 |
| 1861917742 | Jacob Lonnie Erbes | Physical Medicine & Rehabilitation | 430 5th St N, Breckenridge, MN 56520-1426 | 2017-08-11 |
| 1942724372 | Tyler Donn Groth | Physical Therapist | 430 5th St N, Breckenridge, MN 56520-1426 | 2017-07-27 |
| 1194265280 | Janey Bulson | Specialist/Technologist | 430 5th St N, Breckenridge, MN 56520-1426 | 2017-03-08 |
| 1962950667 | Jenna Buckwalter | Physical Therapist | 430 5th St N, Breckenridge, MN 56520-1426 | 2016-09-12 |
| 1659827848 | Kelsey Sue Wienbar | Speech-Language Pathologist | 430 5th St N, Breckenridge, MN 56520-1426 | 2016-08-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831311349 | Carrie Marie Voightman | Occupational Therapist | 1110 Hwy 75, Suite A, Breckenridge, MN 56520 | 2007-05-03 |
| 1063542371 | Jan E Ketterling | Psychologist | 2400 St Francis Drive, Hope Unit St Francis Medical Center, Breckenridge, MN 56520 | 2007-03-06 |
| 1174668081 | Timoth Y John Peterson | General Acute Care Hospital | St. Francis Healthcare Campus, 2400 St. Francis Drive, Breckenridge, MN 56520 | 2007-02-20 |
| 1699859942 | Gerald Dale Brudvik | Dentist | 430 Oak St., Breckenridge, MN 56520 | 2006-10-24 |
| 1881794642 | Pamela Jean Thompson | Social Worker | 415 1/2 Nebraska Ave., Breckenridge, MN 56520 | 2006-09-22 |
| 1588600928 | Robert C Eelkema | Emergency Medicine | 2400 St Francis Dr, Breckenridge, MN 56520 | 2006-06-22 |
| 1639162381 | St. Francis Medical Center | General Acute Care Hospital | 2400 St. Francis Drive, Breckenridge, MN 56520 | 2005-08-29 |
| 1194158899 | Randi Jo Resler | Counselor | 2400 St. Francis Drive, Breckenridge, MN 56520 | 2013-08-16 |
| 1912220229 | Community Addiction Recovery Enterprises | Clinic/Center | 3850 200th Ave, Breckenridge, MN 56520 | 2010-03-02 |
| 1154521516 | Laurie Jo Ann Kessler | Counselor | 2400 St. Francis Drive, Breckenridge, MN 56520 | 2007-07-23 |
| Find all providers in zip 56520 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1689161077 | Chs Tennessee Medical P C | Clinic/Center | 701 Brooks Ave S, Thief River Falls, MN 56701-2757 | 2018-04-20 |
| 1427557867 | Gillette Children's Specialty Healthcare | Clinic/Center | 505 Paul Bunyan Dr Nw, Bemidji, MN 56601-2400 | 2018-02-11 |
| 1992224331 | Orthopedic & Sports Physical Therapy, Inc. | Clinic/Center | 322 N Tower Rd, Fergus Falls, MN 56537-1015 | 2017-09-18 |
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| Find all providers with the same taxonomy | ||||
| City | BRECKENRIDGE |
| Zip Code | 56520 |
Please comment or provide details below to improve the information on ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.