Southshore Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SOUTHSHORE PHYSICAL THERAPY PLLC

Practice address

104 12TH Ave NW Unit 5
Hazen, ND 58545-4106

Phone

(701) 891-2043

NPI assigned

Feb 14, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Miller, PTNPI 1902191778

Title

Owner

Phone

(701) 891-2043

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas Jon Miller

  • Physical Therapist
  • Bismarck, ND
  • NPI 1902191778
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1134874654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 12TH AVE NW UNIT 5",
            "city": "HAZEN",
            "state": "ND",
            "postal_code": "585454106",
            "telephone_number": "701-891-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 12TH AVE NW UNIT 5",
            "city": "HAZEN",
            "state": "ND",
            "postal_code": "585454106",
            "telephone_number": "701-891-2043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSHORE PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-891-2043",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Onette Ruffo, DO
• S-6 Senior Services, LLC
• Rachel Savageau, PT, DPT
• Michael L Schmit, MD
• Carin Souther
• Surge Fitness LLC
• Swanson Chiropractic, P.C.
• William C Swanson, D.C.
• Robert Volk
• Leah Ann Weltz

• Physical Therapist in Hazen, ND
• Providers in Hazen, ND by specialty
• Physical Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.