Individual
JODY LEE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 E NICOLLET BLVD STE 100, BURNSVILLE, MN 55337-6772
(952) 460-4900
Mailing address
1411 8TH STREET CT SE, NEW PRAGUE, MN 56071-5401
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
07/30/2007
Last updated
07/30/2007
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