Individual
PAMELA BLOEDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5173
MN
2251X0800X
Orthopedic Physical Therapist
5173
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6405876
MEDICA INDIV PROV ID
MN
01
—
77G03BL
BC INDIV PROV ID
MN
Enumeration date
04/11/2006
Last updated
04/02/2020
Update your record
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