Provider Demographics
NPI:1215080437
Name:UNIVERSITY OF NORTH DAKOTA
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-777-4845
Mailing Address - Street 1:2751 2ND AVE N STOP 9013
Mailing Address - Street 2:HYSLOP SPORTS CENTER ROOM 115
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9013
Mailing Address - Country:US
Mailing Address - Phone:701-777-6572
Mailing Address - Fax:701-777-2536
Practice Address - Street 1:2751 2ND AVE N STOP 9013
Practice Address - Street 2:HYSLOP SPORTS CENTER ROOM 115
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9013
Practice Address - Country:US
Practice Address - Phone:701-777-6572
Practice Address - Fax:701-777-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1205919198OtherPHYSICAL THERAPIST
ND1447668785OtherPHYSICAL THERAPIST
ND1467462127OtherPT
ND1760565634OtherPHYSICAL THERAPIST
ND50841Medicaid