Individual ProviderAndre BlomPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address9000 Waukegan Rd, Suite 100, Morton Grove, IL 60053-2111(847) 779-6050(847) 324-3976PECOS EnrollmentBased on the most recent information from CMS, provider Andre Blom does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1558317438Provider TypeIndividualFull NameBlom, AndreCredentialPTGenderMaleSole ProprietorNoEnumeration Date5/25/2006Last Updated2/1/2013Contact InformationPractice LocationPractice Address9000 Waukegan Rd, Suite 100, Morton Grove, IL 60053-2111Phone(847) 779-6050FaxUnlisted FaxMailing LocationMailing Address900 Rand Rd, Suite 300, Des Plaines, IL 60016-2359Phone(847) 324-3976FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense070-012378Illinois