Individual
KYLE BLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7644 160TH ST W, LAKEVILLE, MN 55044-4442
(952) 985-5444
Mailing address
7644 160TH ST W, LAKEVILLE, MN 55044-4442
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2024
MN
Other
Enumeration date
03/15/2024
Last updated
03/15/2024
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