Provider Demographics
NPI:1073764528
Name:BLOOMQUIST, REBECCA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 N PROVIDENCE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2049
Mailing Address - Country:US
Mailing Address - Phone:610-891-1636
Mailing Address - Fax:484-444-0132
Practice Address - Street 1:1400 N PROVIDENCE RD STE 210
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-891-1636
Practice Address - Fax:484-444-0132
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist