Individual
MR. MICHAEL WAYNE BLOMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2111 RIVERWALK DR, MOORE, OK 73160-2700
(405) 793-7885
Mailing address
2392 COUNTY STREET 2940, BLANCHARD, OK 73010-3624
(405) 224-6639
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TA691
OK
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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