| Doctor Name: | DR. JUSTIN KYLE BLOOD |
| NPI Number: | 1295863934 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, DPT, OCS |
| License Number: | 6905 |
| Business Practice Address: | 4180 Lexington Ave N Shoreview, MN - 551266106 |
| Business Phone Number: | 6512411455 |
| Business Fax Number: | 6512411456 |
| Mailing Address: | 1739 Hillview Rd, SHOREVIEW |
| State: | MN |
| Postal Code: | 551264909 |
| Phone Number: | 6512411455 |
| Fax Number: | 6512411456 |
| NPI Enumeration Date: | 03/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 6905 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |