NPIMap

Organization Active NPI

Pine Peak Therapy LLC

Doing business as Pine Peak Audiology

  • Physical Therapist
  • Fosston, MN
National Provider Identifier
1982477030
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PINE PEAK THERAPY LLC
Doing business as
Pine Peak Audiology
Practice address
903 Hilligoss Blvd SE
Fosston, MN 56542-1541
Phone
(218) 435-1210
Fax
(218) 435-1175
NPI assigned
Oct 31, 2023
Last updated
Jun 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Mallory Alice Vig, OTR/LNPI 1376033357
Title
Occupational Therapist
Phone
(218) 435-1210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Audiologist 231H00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

903 Hilligoss Blvd SE
Fosston, MN 56542-1541

Mailing address

PO Box 300
Fosston, MN 56542-0300
Phone (218) 435-1210

Other practice location 1

103 1st St W
Fosston, MN 56542-1212
Phone (218) 431-0009

Other names 1

  • Pine Peak Audiology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231207001962 MN Part B Supplier - Clinic/Group Practice 8820447493 Receives reassigned benefits from 5 practitioners
Practice locations: Fosston, MN

National Provider Directory

National Provider Directory

Locations

101 1st St W
Fosston, MN 56542

103 1st St W
Fosston, MN 56542
Phone (218) 431-0009

903 Hilligoss Blvd SE
Fosston, MN 56542
Phone (218) 280-1609

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1982477030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565420300",
            "telephone_number": "218-435-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421541",
            "telephone_number": "218-435-1210",
            "fax_number": "218-435-1175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 1st St W",
            "address_purpose": "LOCATION",
            "city": "Fosston",
            "state": "MN",
            "postal_code": "565421212",
            "country_code": "US",
            "telephone_number": "218-431-0009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINE PEAK THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-31",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "VIG",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_middle_name": "ALICE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "218-435-1210",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Peak Audiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fosston, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.