National Provider Identifier Database

BLUE WATER THERAPY LLC
Rehabilitation


Contact Information

BLUE WATER THERAPY, LLC
3321 4TH AVE S STE D
FARGO, ND58103-2235
Phone: 701-200-8181
Fax:
Website:
Specialty Taxonomy Code
* Rehabilitation 261QR0400X

* Indicates primary specialty

NPI Profile & details for BLUE WATER THERAPY, LLC

NPI Number 1245475797
Legal business name
LBN
BLUE WATER THERAPY, LLC
Authorized official GABRIEL EVENSON - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 12/12/2008
Last updated 12/12/2008 - About 17 years ago
Sole proprietor1 Not specified
Identifiers
  • ND License #: 995

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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