Provider Demographics
NPI:1053355016
Name:BLOYER, SHAWN KEN (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:KEN
Last Name:BLOYER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 1ST ST. SW
Mailing Address - Street 2:P.O. BOX 415
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974
Mailing Address - Country:US
Mailing Address - Phone:507-498-3513
Mailing Address - Fax:
Practice Address - Street 1:161 1ST ST SW
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974-1270
Practice Address - Country:US
Practice Address - Phone:507-498-3513
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer