Provider Demographics
NPI:1801308390
Name:BLOMBERG, MEGAN (MS, ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BLOMBERG
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 25TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-5590
Mailing Address - Country:US
Mailing Address - Phone:319-450-5060
Mailing Address - Fax:
Practice Address - Street 1:1447 JACKRABBIT AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-5700
Practice Address - Country:US
Practice Address - Phone:605-688-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer