Individual
THEA M BLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1111 LEFFINGWELL AVE NE, SUITE 200, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Mailing address
1111 LEFFINGWELL AVE NE, SUITE 200, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Taxonomy
Speciality
Code
Description
License number
State
2251H1200X
Hand Physical Therapist
Primary
5501002432
MI
Other
Enumeration date
08/17/2009
Last updated
09/09/2013
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