Organization
RED DOOR PEDIATRIC THERAPY, INC
Active
Other names
Red Door Pediatric Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TIA-LEE WHITTED (FINANCIAL/CREDENTIALING)
(701) 214-5617
Entity
Organization
Contact information
Practice address
2625 N 19TH ST, BISMARCK, ND 58503-0574
(701) 222-3175
(701) 222-3186
Mailing address
2625 N 19TH ST, BISMARCK, ND 58503-0574
(701) 222-3175
(701) 222-3186
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
908
ND
235Z00000X
Speech-Language Pathologist
Primary
862
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1450786
—
ND
05
—
1451283
—
ND
05
—
1452036
—
ND
05
—
1452040
—
ND
05
—
1452184
—
ND
05
—
1454142
—
ND
05
—
1454300
—
ND
05
—
1454835
—
ND
05
—
1454897
—
ND
05
—
1459139
—
ND
05
—
1459816
—
ND
05
—
1461503
—
ND
05
—
1461975
—
ND
05
—
1463121
—
ND
05
—
1464384
—
ND
05
—
1464388
—
ND
05
—
1465117
—
ND
05
—
1465122
—
ND
05
—
1466654
—
ND
05
—
1466867
—
ND
05
—
1467615
—
ND
05
—
1468069
—
ND
05
—
1468739
—
ND
05
—
1469028
—
ND
05
—
1469164
—
ND
05
—
1470224
—
ND
05
—
1474097
—
ND
05
—
1476591
—
ND
05
—
1477752
—
ND
05
—
1477918
—
ND
05
—
1477950
—
ND
05
—
1477997
—
ND
05
—
1480013
—
ND
05
—
1480766
—
ND
05
—
1480833
—
ND
05
—
1481160
—
ND
Enumeration date
11/02/2006
Last updated
12/05/2024
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