DR. ANTHONY HEATH CHARBONNEAU (NPI# 1417473448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417473448 |
| Entity Type | Individual |
| Full Name | DR. ANTHONY HEATH CHARBONNEAU |
| Credential | PT, DPT |
| Practice Address |
736 Broadway N Fargo ND 58122 |
| Mailing Address |
4740 Timber Pkwy S Apt 312 Fargo ND 58104-4823 |
| Practice Telephone | 7012346735 |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2019-06-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | 1963 | ND | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
1963 | ND | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
736 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700856911 | Douglas M Griffin | Family Medicine | 736 Broadway N, Fargo, ND 58102-4421 | 2006-01-23 |
| 1528666914 | Brett Brockpahler | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2020-10-16 |
| 1235756040 | Ramneet Kaur Singh | Family Medicine | 736 Broadway N, Fargo, ND 58102-4421 | 2020-06-26 |
| 1467002733 | Cassandra Nicole Flach | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2019-09-18 |
| 1710548862 | Jeremiah Johnson | Nurse Practitioner | 736 Broadway N, Fargo, ND 58102-4421 | 2019-06-27 |
| 1659932580 | Randy W Johnson | Nurse Practitioner | 736 Broadway N, Fargo, ND 58102-4421 | 2019-06-21 |
| 1427618800 | Alison Lynn Kopp | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2019-06-18 |
| 1952867178 | Heather Crystal Carkhuff | Physician Assistant | 736 Broadway N, Fargo, ND 58102-4421 | 2019-02-12 |
| 1790256329 | Danielle Jo Matta | Nurse Practitioner | 736 Broadway N, Fargo, ND 58102-4421 | 2018-12-07 |
| 1013483692 | Tamera Ostenaa | Family Medicine | 736 Broadway N, Fargo, ND 58122-4732 | 2018-10-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184142747 | Kayla Estepp | Internal Medicine | 737 Broadway North, Fargo, ND 58122 | 2017-09-05 |
| 1376091793 | Paul Mckay | Physical Therapist | 801 Broadway N., Fargo, ND 58122 | 2016-09-14 |
| 1801290150 | Mark Noah | Physical Therapist | 1720 South University, Fargo, ND 58122 | 2014-10-15 |
| 1245633486 | Diana Palm | Physical Therapist | 1720 University Drive South, Fargo, ND 58122 | 2014-10-02 |
| 1447696406 | Mohamad Imam | Internal Medicine | 801 Broadway North, Fargo, ND 58122 | 2013-05-17 |
| 1457615155 | Chantee Seung Gruenhagen | Nurse Practitioner | 737 North Broadway, Sanford Urology Clinic, Fargo, ND 58122 | 2012-06-27 |
| 1457594079 | Manisha Balhara | Specialist | 2400 32nd Avenue S, Fargo, ND 58122 | 2009-04-13 |
| 1578536728 | Shelby A Terstriep | Internal Medicine | 820 4 Street North, Fargo, NC 58122 | 2006-02-08 |
| 1295229946 | Christopher Hinh | Student in an Organized Health Care Education/Training Program | 801 Broadway North, Fargo, ND 58122 | 2018-06-17 |
| 1558854539 | Suchita Kotnala | Family Medicine | 737 Broadway North, Fargo, ND 58122 | 2018-06-13 |
| Find all providers in zip 58122 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588175061 | Total Balance Physical Therapy and Fitness, LLC | Physical Therapist | 1461 Broadway N Ste 106, Fargo, ND 58102-2622 | 2017-10-23 |
| 1720637630 | Samantha Jo Spaeth | Physical Therapist | 1461 Broadway N, Fargo, ND 58102-2622 | 2019-09-04 |
| 1841693579 | Shayne Marc Spokely | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-08 |
| 1821491614 | Scott Brown | Physical Therapist | 2990 Seter Pkwy S, Fargo, ND 58104-8692 | 2014-10-07 |
| 1558764365 | Mark Brenner | Physical Therapist | 736 Broadway, Physical Therapy, Fargo, ND 58102-1031 | 2014-10-07 |
| 1942603279 | Brian Alan Skjerseth | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-01 |
| 1083017370 | Jennifer Lynn Lamp | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-01 |
| 1780087015 | Greg Grenz | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-01 |
| 1669875092 | James Henry Clapp | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-09-30 |
| 1275936809 | Karen Olson | Physical Therapist | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2014-09-26 |
| 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.