Provider Demographics
NPI:1518010685
Name:BROKAW, ROBYN LYNN (PT)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:LYNN
Last Name:BROKAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:LYNN
Other - Last Name:PIEPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-364-4999
Mailing Address - Fax:701-364-8476
Practice Address - Street 1:407 EAST THIRD STREET
Practice Address - Street 2:ESSENTIA HEALTH ST MARY'S MEDICAL CENTER
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1950
Practice Address - Country:US
Practice Address - Phone:218-786-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13894-24225100000X
HI2285225100000X
MN6439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100257Medicare ID - Type UnspecifiedMEDICARE PROVIDER