Individual
RICHARD BOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
775 PRAIRIE CENTER DR, #250, EDEN PRAIRIE, MN 55344-7314
(952) 944-5314
Mailing address
19540 VINE RIDGE RD, EXCELSIOR, MN 55331-9118
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2704
MN
Other
Enumeration date
08/20/2006
Last updated
07/08/2007
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