Provider Demographics
NPI:1093010662
Name:BLOOM, VICTORIA RENEE (MPT, CWS)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:RENEE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:747 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3504
Practice Address - Country:US
Practice Address - Phone:215-850-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32897225100000X
NJ40QA01653200225100000X
DEJ1-0003396225100000X
PA015786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist