# BLOOM PHYSICAL THERAPY AND WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649855230
- **Authorized official:** JESSICA R BLAISDELL DPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (651) 395-7686

## Contact information

- **Practice address:** 270 72ND ST N, MAHTOMEDI, MN 55115-2079
- **Practice address phone:** (651) 497-6997
- **Mailing address:** 270 72ND ST N, MAHTOMEDI, MN 55115-2079
- **Mailing address phone:** (651) 395-7686
- **Mailing address fax:** (651) 413-2290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2021
- **Last updated:** 09/14/2021