Individual
CLEO B BLOOMQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
16030 BOTHELL EVERETT HWY STE 140, MILL CREEK, WA 98012-1273
(425) 338-9005
(426) 337-0931
Mailing address
8510 186TH ST SW, EDMONDS, WA 98026-5733
(425) 778-2084
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT00003405
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8367559
—
WA
01
—
BL5114
REGENCE PIN#
WA
Enumeration date
07/04/2006
Last updated
07/08/2007
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