Provider Demographics
NPI:1164549838
Name:BLOOMQUIST, AMY A (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 N 26TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4746
Mailing Address - Country:US
Mailing Address - Phone:402-465-0010
Mailing Address - Fax:402-465-0015
Practice Address - Street 1:4900 N 26TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4746
Practice Address - Country:US
Practice Address - Phone:402-465-0010
Practice Address - Fax:402-465-0015
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic