Active NPI
Katie Marie Bradshaw, PT
- Physical Therapist
- Fargo, ND
National Provider Identifier
1114048378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1617
- Practice address
- 4110 51St Ave S
Fargo, ND 58104-7776 - Phone
- (701) 364-4222
- NPI assigned
- Apr 3, 2007
- Last updated
- Dec 20, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7562 | MN | |
| Physical Therapist | 225100000X | 1617 | ND | Primary |
Addresses
Primary practice location
4110 51St Ave S
Fargo, ND 58104-7776
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-6800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114048378 | Medicaid | MN | |
| 55992 | Medicaid | ND |
Other names 1
- Katie Marie Sauvageau
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7562 | MN | MD | Clinical Social Worker |
| 1617 | ND | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myofascial Release by Katie | Physical Therapist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Fargo, ND
- NPI 1487255295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482192000000",
"number": "1114048378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6001",
"city": "FARGO",
"state": "ND",
"postal_code": "581086001",
"telephone_number": "701-364-6800",
"fax_number": "701-364-6828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4110 51ST AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581047776",
"telephone_number": "701-364-4222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "KATIE",
"middle_name": "MARIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2016-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "7562",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "1617",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1114048378",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "55992",
"state": "ND"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KATIE",
"last_name": "SAUVAGEAU",
"middle_name": "MARIE",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.