Provider Demographics
NPI:1295863934
Name:BLOOD, JUSTIN KYLE (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KYLE
Last Name:BLOOD
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1739 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-4909
Mailing Address - Country:US
Mailing Address - Phone:651-241-1455
Mailing Address - Fax:651-241-1456
Practice Address - Street 1:4180 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-6106
Practice Address - Country:US
Practice Address - Phone:651-241-1455
Practice Address - Fax:651-241-1456
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic