Provider Demographics
NPI:1114340536
Name:STOREVIK, ROBERT M (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:STOREVIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 2ND ST
Mailing Address - Street 2:#109
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1125
Mailing Address - Country:US
Mailing Address - Phone:763-439-3259
Mailing Address - Fax:
Practice Address - Street 1:2151 HAMLINE AVE N
Practice Address - Street 2:#111
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4236
Practice Address - Country:US
Practice Address - Phone:651-636-5560
Practice Address - Fax:651-636-4406
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist