Basic Information
| Provider Information | |||||||||
| NPI: | 1659524932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POCERNICH | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | LILLIAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7541 9TH ST N | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551286626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517484338 | ||||||||
| FaxNumber: | 6517482892 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 VILLA COURT DR | ||||||||
| Address2: | |||||||||
| City: | CROMWELL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557264503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186440910 | ||||||||
| FaxNumber: | 2186440911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2008 | ||||||||
| LastUpdateDate: | 12/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6163 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.