Provider Demographics
NPI:1871853010
Name:BLOMS, KIM (DPT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:BLOMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 FORT LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-7930
Mailing Address - Country:US
Mailing Address - Phone:701-471-6122
Mailing Address - Fax:
Practice Address - Street 1:1702 E MAIN ST # 103
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3818
Practice Address - Country:US
Practice Address - Phone:701-415-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics