Provider Demographics
NPI:1023563236
Name:CARLBLOM, JASMIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:CARLBLOM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6776 LAKE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6776 LAKE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014
Practice Address - Country:US
Practice Address - Phone:651-784-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X
MN10252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics