Provider Demographics
NPI:1063113470
Name:UP NORTH PHYSICAL THERAPY
Entity type:Organization
Organization Name:UP NORTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BLEESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:218-242-4633
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WARROAD
Mailing Address - State:MN
Mailing Address - Zip Code:56763-0344
Mailing Address - Country:US
Mailing Address - Phone:218-242-4633
Mailing Address - Fax:218-986-0890
Practice Address - Street 1:608 EMILY AVE NW
Practice Address - Street 2:
Practice Address - City:WARROAD
Practice Address - State:MN
Practice Address - Zip Code:56763-2706
Practice Address - Country:US
Practice Address - Phone:218-242-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty