Provider Demographics
NPI:1164462446
Name:STOKMAN, PAUL WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:STOKMAN
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 1:1125 CEDAR ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-4663
Mailing Address - Country:US
Mailing Address - Phone:763-295-4201
Mailing Address - Fax:763-295-3895
Practice Address - Street 1:1125 CEDAR ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4663
Practice Address - Country:US
Practice Address - Phone:763-295-4201
Practice Address - Fax:763-295-3895
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN086G6STOtherBCBS OF MN
MN650001782OtherPTAN
MNP00266011OtherRAILROAD MEDICARE
MN6405115OtherMEDICA
MNHP34792OtherHEALTHPARTNERS
MN691558200Medicaid
MN6405115OtherSELECT CARE