Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10252 | MN |
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1023563236 |
---|---|
Provider Name | Jasmin Carlblom |
First Address | Lino Lakes, MN 55014-1192 |
Second Address | Lino Lakes, MN 55014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2016 |
Last Update Date | 08/11/2019 |