Individual
MR. LONNIE N BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
110 N LAVENTURE RD, STE A, MOUNT VERNON, WA 98273-3901
(360) 428-2700
(360) 428-2701
Mailing address
110 N LAVENTURE RD, STE A, MOUNT VERNON, WA 98273-3901
(360) 428-2700
(360) 428-2701
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00007498
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7155104
—
WA
Enumeration date
08/10/2005
Last updated
04/23/2008
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