Shanna M Bloomgren, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TE013143 Issued in PA

Practice address

12680 Perry Hwy Ste 105
Wexford, PA 15090-8887

Phone

(724) 720-4510

NPI assigned

Sep 20, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Core Network, LLC

  • Physical Therapist
  • Pittsburgh, PA
  • NPI 1871551028

  Physical Therapy Assistant

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1689452534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12680 PERRY HWY STE 105",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150908887",
            "telephone_number": "724-720-4510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12680 PERRY HWY STE 105",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150908887",
            "telephone_number": "724-720-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMGREN",
        "first_name": "SHANNA",
        "middle_name": "M",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE013143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Blakemore
• Morgan Blanco, LPC
• Carolyn Bland
• Elizabeth Blasik
• Sandra Alane Block, LCSW
• Blossom Physical Therapy and Wellness LLC
• Boivin Family Chiropractic PLLC
• Randal Robert Boivin, DC
• Leyna Bonanno, LPC
• Madison Book, OTR/L

• Physical Therapy Assistant in Wexford, PA
• Providers in Wexford, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.