Healthcare Provider Details

I. General information

NPI: 1699679316
Provider Name (Legal Business Name): BLOOM INSTITUTE OF PELVIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E ROWAN AVE STE L2
SPOKANE WA
99207-1281
US

IV. Provider business mailing address

17208 HAMILTON LN
COLBERT WA
99005-5105
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-7837
  • Fax:
Mailing address:
  • Phone: 208-819-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MCKENNA YOUNG
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 208-819-7837