Provider Demographics
NPI:1053314120
Name:BLOOM, DANIELLE E (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:E
Last Name:BLOOM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:E
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2800 S SHIRLINGTON RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3605
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-521-3415
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 1100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3605
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-521-3415
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203566225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ928731Medicaid
AZZ102726Medicare PIN
AZ928731Medicaid