Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1157647 | TX |
NPI | 1255952115 |
---|---|
Provider Name | Kristy Bloom |
First Address | Frisco, TX 75036-4642 |
Second Address | Dallas, TX 75234-7385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2020 |
Last Update Date | 01/05/2020 |