CHRISTOPHER PEROUTKA (NPI# 1124523576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124523576 |
| Entity Type | Individual |
| Full Name | CHRISTOPHER PEROUTKA |
| Credential | ATC |
| Practice Address |
1300 17th Ave N Fargo ND 58102 |
| Mailing Address |
5316 Heron Trl Middleton WI 53562-5215 |
| Practice Telephone | 7012316378 |
| Mailing Telephone | 6084453413 |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-03-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1300 17TH AVE N |
| City | FARGO |
| State | ND |
| Zip Code | 58102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992365498 | Kathleen Yvette Gallais | Emergency Medical Technician, Basic | 1300 17th Ave N, Fargo, ND 58102 | 2019-06-17 |
| 1124519913 | Lucas William Lammert | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| 1639457112 | Amanda Marie Williams | Speech-Language Pathologist | 415 4th St. N. Fargo Public Schools, Fargo, ND 58102 | 2011-08-01 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225640170 | Jordan Chase Elliott | Specialist/Technologist | 1800 University Dr N, Fargo, ND 58102-2241 | 2020-08-21 |
| 1235769712 | Kathleen Freebern | Specialist/Technologist | 4780 Timber Pkwy S Apt 103, Fargo, ND 58104-4837 | 2020-01-23 |
| 1245793330 | Mara Jungels | Specialist/Technologist | 1837 University Dr N, Fargo, ND 58105-2504 | 2019-04-07 |
| 1215493374 | Kayla Marie Hennum | Specialist/Technologist | 1225 2nd St N, Fargo, ND 58102-2722 | 2019-02-13 |
| 1740745405 | Anna Marie St Catherine | Specialist/Technologist | 1709 35th St S Apt 416, Fargo, ND 58103-4883 | 2019-02-07 |
| 1417411380 | Tara Dawn Gebur | Specialist/Technologist | 3200 22nd St S Apt C42, Fargo, ND 58104-6570 | 2019-01-24 |
| 1427522754 | Dana Vander Wal | Specialist/Technologist | 315 30th Ave N Apt 16, Fargo, ND 58102-1567 | 2019-01-21 |
| 1912471210 | Kaitlyn Dorsher | Specialist/Technologist | 1113 18th St N Apt C, Fargo, ND 58102-3306 | 2019-01-20 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1013425149 | Mason Ankenbauer | Specialist/Technologist | 1301 Centennial Blvd, Fargo, ND 58108 | 2018-01-10 |
| Find all providers in FARGO | ||||
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| 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.