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NPI Profile for THEA M BLOM in GRAND RAPIDS, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Hand |
2251H1200X | 65 | Physical Therapist in Private Practice |
| NPI # | 1619109295 |
|
| Status | Active | |
| Credentials | PT (Physical Therapist) | |
| Entity | Individual | |
| Enumeration date | 08/17/2009 | |
| Last updated | 09/09/2013 - About 13 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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THEA M BLOM
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THEA M BLOM, PT