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Individual

TY BLOOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
207 PARKER ST, BOSCOBEL, WI 53805-1642
(608) 375-6342
Mailing address
207 PARKER ST, BOSCOBEL, WI 53805-1642

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3227-19
WI

Other

Enumeration date
10/04/2021
Last updated
10/04/2021
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