Healthcare Provider Details

I. General information

NPI: 1215676655
Provider Name (Legal Business Name): BRANDON ROBERT KROGMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 STATE AVE
FARIBAULT MN
55021-6368
US

IV. Provider business mailing address

2474 TIMBERWOOD LN NE
OWATONNA MN
55060-2562
US

V. Phone/Fax

Practice location:
  • Phone: 507-497-3790
  • Fax:
Mailing address:
  • Phone: 507-676-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: