Kelly J Vander Bloomen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

38019 Issued in FL

Practice address

4107 N Himes Ave Ste 100
Tampa, FL 33607-6645

Phone

(813) 874-1009

NPI assigned

Aug 23, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• Optimum HealthCare HMO Network

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.

• Bodycentral Physical Therapy P C

  • Physical Therapy Clinic/Center
  • Tucson, AZ
  • NPI 1629057930
  NPD (past)
• Bodycentral Physical Therapy PC

  • Customized Equipment (DME)
  • Tucson, AZ
  • NPI 1780899369
  NPD (past)

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1902112469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S HARBOUR ISLAND BLVD UNIT 513",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336026705",
            "telephone_number": "813-833-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4107 N HIMES AVE STE 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076645",
            "telephone_number": "813-874-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER BLOOMEN",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11510",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9316",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "43565",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1217489",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "38019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frederick A Vance, DDS
• Vancorp Holdings, Inc. (Cerna HomeCare of Tampa)
• Reese Vandeboe, RBT
• Holly Vandeman, MD
• Laura Elizabeth Vandenberg, OD
• Lauren Vandergrift, LMT
• Elizabeth Anne Vanderlinden, COTA/L
• Rodney Dirk Vanderploeg, PH.D.
• Annelies Vanderveen
• Hendrikus S Vanderveldt, MD

• Physical Therapist in Tampa, FL
• Providers in Tampa, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.