Provider Demographics
NPI:1972030260
Name:PETROSKE, CRAIG M
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:PETROSKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2909
Mailing Address - Country:US
Mailing Address - Phone:218-362-7100
Mailing Address - Fax:218-362-7131
Practice Address - Street 1:1120 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2909
Practice Address - Country:US
Practice Address - Phone:218-362-7100
Practice Address - Fax:218-362-7131
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist