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

Mr. Michael Wayne Blomstrom, PTA

Individual provider Physical Therapy Assistant · NPI 1104944495

Mr. Michael Wayne Blomstrom, PTA is a Physical Therapy Assistant in Moore, Oklahoma. Licensed in Oklahoma. Registered with an NPI since 2007.

Licensed in
OK
In the registry since
2007
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

2111 Riverwalk Dr
Moore, OK 73160-2700
Phone: (405) 793-7885
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence TA691 (OK)

Record details

NPI number1104944495
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedMarch 26, 2007
Last updated in NPPESJuly 8, 2007
Mailing address2392 County Street 2940, Blanchard, OK 73010-3624

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