Provider Demographics
NPI:1588631899
Name:THROCKMORTON, RALPH JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:JAMES
Last Name:THROCKMORTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9138 BATAAN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5615
Mailing Address - Country:US
Mailing Address - Phone:763-784-2340
Mailing Address - Fax:763-786-1046
Practice Address - Street 1:8290 UNIVERSITY AVE NE
Practice Address - Street 2:300
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1847
Practice Address - Country:US
Practice Address - Phone:763-784-2340
Practice Address - Fax:763-786-1046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist