Michael Wayne Blomstrom, PTA
Individual provider Active NPI Physical Therapy Assistant · Moore, OK
NPI 1104944495 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104944495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- TA691 (OK)
- Practice address
- 2111 Riverwalk Dr
Moore, OK 73160-2700 - Phone
- (405) 793-7885
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA691 | OK | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | TA691 | OK | Yes |
Addresses
Primary practice location
2111 Riverwalk Dr
Moore, OK 73160-2700
Mailing address
2392 County Street 2940
Blanchard, OK 73010-3624
Phone (405) 224-6639
Other providers in Moore, OK
- Bitanor Corp
- BJT MD PLLC
- William Blackwood
- Lori Deon Blair
- Abbie Blalock
- Bluebirdmassageandwellness, PLLC
- Randi Bock
- Bodin Chiropractic PLLC
- Tyler Ray Bodin
- Tanner Lee Boles
All providers in Moore, OK · Physical Therapy Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.