Healthcare Provider Details

I. General information

NPI: 1184576266
Provider Name (Legal Business Name): DAWN CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SW 22ND AVE
GRAND RAPIDS MN
55744-3067
US

IV. Provider business mailing address

19184 ASHLEY LN
GRAND RAPIDS MN
55744-5795
US

V. Phone/Fax

Practice location:
  • Phone: 218-259-8380
  • Fax:
Mailing address:
  • Phone: 218-259-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number6379
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: