Organization
MYOFASCIAL RELEASE BY KATIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE MARIE BRADSHAW PT (CEO/OWNER)
(612) 432-5305
Entity
Organization
Contact information
Practice address
3441 45TH ST S, FARGO, ND 58104-8970
(701) 660-5104
Mailing address
2406 14TH ST W, WEST FARGO, ND 58078-8441
(612) 432-5305
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251E1200X
Ergonomics Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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