Provider Demographics
NPI:1437596152
Name:BLOOMQUIST, SUZANNE RENEE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RENEE
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RENEE
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:8100 W 78TH ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2516
Mailing Address - Country:US
Mailing Address - Phone:952-946-9777
Mailing Address - Fax:952-946-9888
Practice Address - Street 1:8100 W 78TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2516
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:952-946-9888
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer