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NPI Code Detail

MEDICARE: MRS. CAROLYN JEAN POBLOCKI PT

MEDICARE: MRS. CAROLYN JEAN POBLOCKI PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2670MN

General Provider Information

NPI Number : 1598998395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROLYN JEAN POBLOCKI PT
Provider Business Mailing Address
First Line : 4859 142ND ST W
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-7717
Country : US
Telephone Number : 952-412-1505
Fax Number :
Provider Business Practice Location Address
First Line : 815 FOREST AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1643
Country : US
Telephone Number : 507-646-8441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2009
Last Update Date : 08/26/2009

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