Provider Demographics
NPI:1114927407
Name:BLOOMENSTEIN, CHARINA A (PT)
Entity Type:Individual
Prefix:MS
First Name:CHARINA
Middle Name:A
Last Name:BLOOMENSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9746 N 90TH PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5083
Mailing Address - Country:US
Mailing Address - Phone:480-443-3534
Mailing Address - Fax:480-367-9515
Practice Address - Street 1:9746 N 90TH PL
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5083
Practice Address - Country:US
Practice Address - Phone:480-443-3534
Practice Address - Fax:480-367-9515
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27424Medicare ID - Type Unspecified