Provider Demographics
NPI:1982947370
Name:BLOEMENDAL, JENNIFER MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:BLOEMENDAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:85 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1648
Mailing Address - Country:US
Mailing Address - Phone:651-404-1002
Mailing Address - Fax:
Practice Address - Street 1:85 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1648
Practice Address - Country:US
Practice Address - Phone:651-404-1002
Practice Address - Fax:615-404-1199
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11987-24225100000X
MN10146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10146OtherPHYSICAL THERAPY LICENSE
WI11987-24OtherPHYSICAL THERAPY LICENSE