Provider Demographics
NPI:1083157978
Name:BLSCK, CIMONE
Entity Type:Individual
Prefix:
First Name:CIMONE
Middle Name:
Last Name:BLSCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 OLD CEDAR AVE S APT 207
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-2345
Mailing Address - Country:US
Mailing Address - Phone:612-986-2520
Mailing Address - Fax:
Practice Address - Street 1:710 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2916
Practice Address - Country:US
Practice Address - Phone:612-450-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist