Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Michael Bloom, DPT

Individual provider Physical Therapist · NPI 1679492052

Jack Michael Bloom, DPT is a Physical Therapist in Republic, Washington. Practices as a sole proprietor. Licensed in Kansas.

Licensed in
KS
In the registry since
2026
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

See every abbreviation used in this directory →

Practice location Address checks out

10 Ros Cir
Republic, WA 99166-5002
Phone: (509) 775-8400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 11-08197 (KS)

Record details

NPI number1679492052
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorYes
NPI enumeratedJuly 10, 2026
Last updated in NPPESJuly 10, 2026
Certification dateJuly 10, 2026
Mailing address730 Hockaday St, Council Grove, KS 66846-1814

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