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General NPI Number Information
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NPI Number | 1962163527
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Entity Type | Organization
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Legal Business Name | BLOSSOM PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 17632 140TH AVE NE
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City | WOODINVILLE
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State | WA
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Zip | 98072-8514
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Country | US
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Telephone | 206-295-3870
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Fax |
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Provider Business Mailing Address
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Address Line | 19804 77TH PL NE
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City | KENMORE
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State | WA
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Zip | 98028-2162
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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 | OWNER
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Name | HEIDI MARTEN
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Credential |
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Telephone | 206-295-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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