Provider Demographics
NPI:1902966104
Name:BLOM, ELIZABETH (LPT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BLOM
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 HUEBNER RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1558
Mailing Address - Country:US
Mailing Address - Phone:210-481-7730
Mailing Address - Fax:210-481-7731
Practice Address - Street 1:9150 HUEBNER RD
Practice Address - Street 2:SUITE 340
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1558
Practice Address - Country:US
Practice Address - Phone:210-481-7730
Practice Address - Fax:210-481-7731
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11572002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4258OtherBCBS
TX8D2326Medicare UPIN
TX8D2326Medicare PIN