Provider Demographics
NPI:1447537592
Name:BLOOM, MARGARET M (LMT, NCTMB)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1115
Mailing Address - Country:US
Mailing Address - Phone:406-827-9527
Mailing Address - Fax:406-827-9527
Practice Address - Street 1:410 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-1115
Practice Address - Country:US
Practice Address - Phone:406-827-9527
Practice Address - Fax:406-827-9527
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist