BLUE WATER THERAPY, LLC; NPI #1245475797

Contact Information

BLUE WATER THERAPY, LLC

3321 4TH AVE S STE D
FARGO, ND 58103-2235

Phone: 701-200-8181
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Rehabilitation	261QR0400X	B4[14]	Rehabilitation Agency

Indicates primary specialty

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NPI Profile & details for BLUE WATER THERAPY, LLC

NPI Number 1245475797

LBN Legal business name BLUE WATER THERAPY, LLC

Authorized official GABRIEL EVENSON - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 12/12/2008

Last updated 12/12/2008 - About 17 years ago

Identifiers

License #

995

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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