Myofascial Release by Katie

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MYOFASCIAL RELEASE BY KATIE

Practice address

3441 45TH St S
Fargo, ND 58104-8970

Phone

(701) 660-5104

NPI assigned

Nov 6, 2020

Organization subpart

No

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

Authorized official

Name

Katie Marie Bradshaw, PTNPI 1114048378

Title

Ceo/Owner

Phone

(612) 432-5305

Specialties & licenses 5

Addresses

Practitioners 1

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

• Katie Marie Bradshaw, PT

  • Physical Therapist
  • Fargo, ND
  • NPI 1114048378
  NPD Authorized official

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1487255295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 14TH ST W",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580788441",
            "telephone_number": "612-432-5305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3441 45TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048970",
            "telephone_number": "701-660-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYOFASCIAL RELEASE BY KATIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-06",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "612-432-5305",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251E1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Ergonomics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy O Mykleseth, LCSW
• Mickey Myles
• Myna Early Intervention LLC
• Myna Therapy Services PLLC
• Mynd Integrated LLC
• Wendy Ann Myren
• Jason C Myrmoe, MD
• Briana R Myrvik, B. S.
• N.I.a.M Brain Injury Services, LLP
• Amanda Nack

• Physical Therapist in Fargo, ND
• Providers in Fargo, 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 Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.