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General NPI Number Information
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NPI Number | 1457012817
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Entity Type | Individual
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Provider Name | SHELBY BLOOMQUIST
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Gender | Female
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 20 E PICCADILLY ST STE 11&14
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City | WINCHESTER
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State | VA
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Zip | 22601-3971
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Country | US
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Telephone | 877-407-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 8256 W CLIFTON AVE
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City | LITTLETON
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State | CO
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Zip | 80128-5586
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Country | US
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Telephone | 720-982-8912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P20393
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License Number State | NC
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