Provider Demographics
NPI:1104907799
Name:SCHWEGMAN-NORUM, CARRIE (RPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:SCHWEGMAN-NORUM
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LOMOND LOOP
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1656 CENTRAL ST W
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-4357
Practice Address - Country:US
Practice Address - Phone:218-694-6640
Practice Address - Fax:218-694-6380
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6403732OtherMEDICA
MNP00852247OtherRR MEDICARE
MN1104907799Medicaid
MN616055700Medicaid
MNOS1L7SCOtherBCBS
MN1104907799Medicaid
MN650002437Medicare PIN
MN246533Medicare ID - Type UnspecifiedHDR