Brett Hample, DPT, PT
Individual provider Active NPI Physical Therapist · Dickinson, ND
NPI 1649628629 · NPPES record last updated May 31, 2016
Key facts
- NPI
- 1649628629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1935 (ND)
- Practice address
- 2500 Fairway St
Dickinson, ND 58601-2639 - Phone
- (701) 456-4387
- NPI assigned
- May 31, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Elite PT
Practice addresses (Care Compare)
1674 15TH St W
Suite 1
Dickinson, ND 58601-2811
Phone (701) 483-8686
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240627001607 | ND | Practitioner - Physical Therapist in Private Practice | 1557805835 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1935 | ND | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite PT | Physical Therapist | Current |
Accepting new patients |
Locations
1674 15th St W
Ste 1
Dickinson, ND 58601
Phone (701) 260-2046
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1935 | ND | Yes |
Addresses
Primary practice location
2500 Fairway St
Dickinson, ND 58601-2639
Mailing address
2500 Fairway St
Dickinson, ND 58601-2639
Phone (701) 456-4387
Other providers in Dickinson, ND
- Shelly Marie Hall
- Jessica Halonen
- Valerie Lynn Halonen
- Eric Halverson
- Tana L Hamann
- Jacy M Hansey
- Michelle Suzanne Hanson
- John B Hanstad
- Rachel Harrell
- Lexi Hauck
All providers in Dickinson, ND · Physical Therapist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.