Provider Demographics
NPI:1598998395
Name:POBLOCKI, CAROLYN JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JEAN
Last Name:POBLOCKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 142ND ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7717
Mailing Address - Country:US
Mailing Address - Phone:952-412-1505
Mailing Address - Fax:
Practice Address - Street 1:815 FOREST AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1643
Practice Address - Country:US
Practice Address - Phone:507-646-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist