Provider Demographics
NPI:1275638603
Name:STOKKE, KARA KOLQUIST (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:KOLQUIST
Last Name:STOKKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:KOLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 LONDON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2433
Mailing Address - Country:US
Mailing Address - Phone:218-728-3774
Mailing Address - Fax:218-728-3640
Practice Address - Street 1:1420 LONDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2433
Practice Address - Country:US
Practice Address - Phone:218-728-3774
Practice Address - Fax:218-728-3640
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36102400Medicaid
MN093H7KOOtherBCBSMN INDIVIDUAL
MN6406275OtherMEDICA INDIVIDUAL