Provider Demographics
NPI:1356171581
Name:BLOMSTROM, EMMA RILEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:RILEY
Last Name:BLOMSTROM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAIN ST UNIT 15-318
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3886
Mailing Address - Country:US
Mailing Address - Phone:413-404-1154
Mailing Address - Fax:
Practice Address - Street 1:65 PORTLAND RD STE 5
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6742
Practice Address - Country:US
Practice Address - Phone:207-985-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist