| Doctor Name: | MR. LONNIE N BLOOM |
| NPI Number: | 1154322394 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT00007498 |
| Business Practice Address: | 110 N Laventure Rd Ste A Mount Vernon, WA - 982733901 |
| Business Phone Number: | 3604282700 |
| Business Fax Number: | 3604282701 |
| Mailing Address: | 110 N Laventure Rd, Ste A MOUNT VERNON |
| State: | WA |
| Postal Code: | 982733901 |
| Phone Number: | 3604282700 |
| Fax Number: | 3604282701 |
| NPI Enumeration Date: | 08/10/2005 |
| NPI Last Update Date: | 04/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT00007498 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |