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General NPI Number Information
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NPI Number | 1750602090
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Entity Type | Individual
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Provider Name | CHAD ALAN BLOMQUIST LMT
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Gender | Male
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 6860 SAINT EDMUNDS LOOP
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City | FORT MYERS
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State | FL
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Zip | 33966-7503
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Country | US
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Telephone | 309-948-3213
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 17TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-3868
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 005795
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.010795
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA102775
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License Number State | FL
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