Individual
KELSEY SHAE BLOEMKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 WATKINS ST, CISNE, IL 62823
(618) 673-2177
Mailing address
9619 E 400TH AVE, MASON, IL 62443-2325
(217) 690-5814
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160008269
IL
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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