Provider Demographics
NPI:1902971278
Name:CARR, STEVEN ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:CARR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 33RD ST S STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9668
Mailing Address - Country:US
Mailing Address - Phone:320-240-6955
Mailing Address - Fax:320-240-8089
Practice Address - Street 1:1301 33RD ST S STE 210
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-9668
Practice Address - Country:US
Practice Address - Phone:320-240-6955
Practice Address - Fax:320-240-8089
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
MN2070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN584224700Medicaid
MN7B068CAOtherBLUE CROSS BLUE SHIELD
MNHP43510OtherHEALTHPARTNERS
MN6402742OtherMEDICA
MN6402742OtherSELECT CARE
MN6402742OtherMEDICA
MNP00284166Medicare PIN
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN584224700Medicaid