Provider Demographics
NPI:1437173945
Name:AT-HOME PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:AT-HOME PHYSICAL THERAPY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STROH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-293-7294
Mailing Address - Street 1:4674 40TH AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4500
Mailing Address - Country:US
Mailing Address - Phone:701-293-7294
Mailing Address - Fax:701-282-9738
Practice Address - Street 1:4674 40TH AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4500
Practice Address - Country:US
Practice Address - Phone:701-293-7294
Practice Address - Fax:701-282-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5789225100000X
ND489225X00000X
MN100824225X00000X
ND962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND025172OtherMEDICA
ND06456001OtherBCBS OF NORTH DAKOTA
ND06456001OtherBCBS OF NORTH DAKOTA
ND025172OtherMEDICA
NDDE4117Medicare ID - Type UnspecifiedMEDICARE RAIL ROAD