BLUE WATER THERAPY, LLC (NPI# 1245475797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245475797 |
| Entity Type | Organization |
| Organization Name | BLUE WATER THERAPY, LLC |
| Practice Address |
3321 4th Ave S Ste D Fargo ND 58103-2235 |
| Mailing Address |
4425 47th St S Fargo ND 58104-4201 |
| Practice Telephone | 7012008181 |
| Mailing Telephone | 7012008181 |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2008-12-12 |
| Authorized Official Name | GABRIEL THOMAS EVENSON (PRESIDENT) |
| Authorized Official Telephone | 7012008181 |
| Authorized Official Credential | MOTR/L |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
995 | ND | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | BLUE WATER THERAPY, LLC | 2928 Se Hawthorne Blvd, Portland, OR 97214 |
| Street Address |
3321 4TH AVE S STE D |
| City | FARGO |
| State | ND |
| Zip Code | 58103-2235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 261QR0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457479958 | Pediatric Therapy Partners, Inc. | Clinic/Center | 3060 Frontier Way South, Fargo, ND 58104 | 2007-03-26 |
| 1861540064 | Milestone Therapeutics Inc | Clinic/Center | 921 43rd Ave N, Fargo, ND 58102-5320 | 2007-01-07 |
| 1114925120 | American Lutheran Homes Inc | Clinic/Center | 201 University Dr S, Fargo, ND 58103-1775 | 2005-07-13 |
| 1134523004 | American Lutheran Homes Inc | Clinic/Center | 201 University Dr S, Fargo, ND 58103-1775 | 2014-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467765420 | Hope Therapy Center, Pllc | Clinic/Center | 107 W Main Ave Ste 300, Bismarck, ND 58501-3871 | 2010-07-20 |
| 1730280371 | Omaha Therapy, Inc | Clinic/Center | 683 State Ave Ste B, Dickinson, ND 58601-4660 | 2006-09-26 |
| 1760930010 | Little Miracles, Inc Pediatric Therapy Clinic | Clinic/Center | 2200 Library Cir, Grand Forks, ND 58201-6326 | 2016-09-15 |
| 1740600774 | Linde, LLC | Clinic/Center | 50 Poplar Ave S, Carrington, ND 58421-2266 | 2014-04-17 |
| 1801195045 | Therapy Solutions LLC | Clinic/Center | 448 21st St W, Suite D1, Dickinson, ND 58601-2647 | 2011-03-25 |
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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.