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Organization

PROFESSIONAL REHABILITATION CENTER INC

Active
Parent organization
PROFESSIONAL REHABILITATION CENTER, INC
Other names
Pro Rehab Center, Inc
Organization subpart
Yes

Provider details

NPI number
Legal business name
PROFESSIONAL REHABILITATION CENTER, INC
Authorized official
MS. TINA D FONDER (OFFICE MANAGER)
(701) 451-9417
Entity
Organization

Contact information

Practice address
4450 31ST AVE S STE 104, FARGO, ND 58104-4557
(701) 451-9417
(701) 298-0066
Mailing address
4450 31ST AVE S STE 104, FARGO, ND 58104-4557
(701) 451-9417
(701) 298-0066

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
ND
225X00000X
Occupational Therapist
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
018T6PR
BLUE PLUS OF MINNESOTA
MN
05
53165
ND
05
53170
ND
01
5517001
BLUE CROSS BLUE SHIELD ND
ND
05
552323100
MN
01
O18T6PR
BLUE CROSS BLUE SHIELD MN
MN
Enumeration date
11/01/2006
Last updated
10/29/2019
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