Provider Demographics
NPI:1124193057
Name:TEMBROCK, PAUL THOMAS (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:TEMBROCK
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 1:251 COUNTY ROAD 120
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-259-5429
Mailing Address - Fax:320-240-8905
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-259-5429
Practice Address - Fax:320-240-8905
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6406241OtherMEDICA
MN6406241OtherSELECT CARE
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN6B504TEOtherBLUE CROSS BLUE SHIELD
MN744023500Medicaid
MNHP43507OtherHEALTHPARTNERS
MN650001451Medicare PIN
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MNHP43507OtherHEALTHPARTNERS