Provider Demographics
NPI:1083783468
Name:BLOMGREN, COLLEEN KROMBACH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:KROMBACH
Last Name:BLOMGREN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 W FOSTER AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1079
Mailing Address - Country:US
Mailing Address - Phone:773-327-2743
Mailing Address - Fax:773-327-0547
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:#142
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-327-2880
Practice Address - Fax:773-327-0547
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist