Provider Demographics
NPI:1841246428
Name:TOBKIN, CARRIE A (PT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:TOBKIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:A
Other - Last Name:BROSSART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0727
Mailing Address - Country:US
Mailing Address - Phone:218-844-2300
Mailing Address - Fax:218-844-2444
Practice Address - Street 1:125 FRAZEE ST E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3501
Practice Address - Country:US
Practice Address - Phone:218-844-2300
Practice Address - Fax:218-844-2444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM37736OtherLHS/BANNERHEALTH #
FM6405176OtherMEDICA #
MN908S3TOOtherMNBS #
MN54906Medicaid
MN1070686OtherAMERICA'S PPO/ARAZ #
FM24979OtherNDBS #
MNHP28535OtherHEALTHPARTNERS #