Individual
MR. MITCHELL R. CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5959 BAKER RD, MINNETONKA, MN 55345-5900
(651) 348-7428
Mailing address
7581 9TH ST N STE 100, OAKDALE, MN 55128-6635
(651) 748-4338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
014144
NY
225100000X
Physical Therapist
Primary
2899
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010114144
BLUE CHOICE
NY
01
—
020114144
BCBS
NY
01
—
145851FT
PREFERRED CARE
NY
01
—
601318000
OWCP
NY
01
—
7735556
AETNA
NY
Enumeration date
10/13/2006
Last updated
09/24/2019
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