Active NPI
Robert John Broxterman, MS, ATC/R
- Specialist
- Robbinsdale, MN
National Provider Identifier
1972552586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1031
- Practice address
- 4080 W Broadway Ave
Robbinsdale, MN 55422-5604 - Phone
- (651) 491-5847
- NPI assigned
- May 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1031 | MN | Primary |
Addresses
Primary practice location
4080 W Broadway Ave
Robbinsdale, MN 55422-5604
Mailing address
1112 California Ave W
Saint Paul, MN 55108-2202
Phone (651) 487-9046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1031 | MN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1972552586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1112 CALIFORNIA AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551082202",
"telephone_number": "651-487-9046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4080 W BROADWAY AVE",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "554225604",
"telephone_number": "651-491-5847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROXTERMAN",
"first_name": "ROBERT",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "MS, ATC/R",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MN",
"license": "1031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Robbinsdale, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.