Provider Demographics
NPI:1043646029
Name:CARLSON, PATRICK DAVID (DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12143 LILY ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-1784
Mailing Address - Country:US
Mailing Address - Phone:763-422-1029
Mailing Address - Fax:
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:#280
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-784-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist