Provider Demographics
NPI:1174029680
Name:BLOEMKER, KATHY JO (PT, MSPT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:BLOEMKER
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 S 140TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2339
Mailing Address - Country:US
Mailing Address - Phone:402-618-3320
Mailing Address - Fax:402-913-3102
Practice Address - Street 1:2510 S 140TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2339
Practice Address - Country:US
Practice Address - Phone:402-618-3320
Practice Address - Fax:402-913-3102
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10608225100000X
NE1285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist