Individual provider Active NPI

Alissa Koenig, DPT

  • Physical Therapist
  • Fargo, ND
National Provider Identifier
1952997207
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2599 Issued in ND
Practice address
1461 Broadway N
Fargo, ND 58102-2622
Phone
(701) 293-6037
NPI assigned
Dec 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2599 ND Primary

Addresses

Primary practice location

1461 Broadway N
Fargo, ND 58102-2622

Mailing address

9047 W. Greenfield Ave.
Milwaukee, WI 53214

Other identifiers 1

IdentifierTypeStateIssuer
2599OtherNDND PHYSICAL THERAPY LICENSE

Other names 1

  • Alissa Elwing Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221027001570 ND Practitioner - Physical Therapist in Private Practice 1759790272 Reassigns benefits to 1 organization
I20221209002657 MN Practitioner - Physical Therapist in Private Practice 1759790272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Balance Physical Therapy and Fitness, LLCGroup PAC ID 8820356991, 37 clinicians

Practice addresses (Care Compare)

1461 Broadway N
Fargo, ND 58102-2622
Phone (701) 293-6037

3501 8TH St S
Moorhead, MN 56560-5155
Phone (701) 293-6037

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2599NDMDPhysical Therapist
12892MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Total Balance Physical Therapy and Fitness, LLC Physical Therapist CurrentSince Oct 10, 2022 Accepting new patients
Total Balance Dietitian, LLC CurrentSince Mar 24, 2024 Accepting new patients

Locations

3501 8th St S
Moorhead, MN 56560
Phone (218) 422-3343

1461 Broadway N
Fargo, ND 58102
Phone (701) 293-6037

2600 52nd Ave S
Fargo, ND 58104
Phone (701) 293-6037

1461 Broadway N
Ste 105
Fargo, ND 58102
Phone (701) 293-6037

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1608508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1952997207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9047 W. GREENFIELD AVE.",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022622",
            "telephone_number": "701-293-6037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "ALISSA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-21",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "2599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND PHYSICAL THERAPY LICENSE",
            "identifier": "2599",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISSA",
            "last_name": "ELWING",
            "credential": "PT, DPT",
            "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 Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.