Provider Demographics
NPI:1306836879
Name:BLOOM & ASSOCIATES THERAPY P A
Entity Type:Organization
Organization Name:BLOOM & ASSOCIATES THERAPY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:785-273-7700
Mailing Address - Street 1:4035 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1916
Mailing Address - Country:US
Mailing Address - Phone:785-273-7700
Mailing Address - Fax:785-273-7551
Practice Address - Street 1:4035 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1916
Practice Address - Country:US
Practice Address - Phone:785-273-7700
Practice Address - Fax:785-273-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014722OtherBCBS PROVIDER NUMBER
KS100331910AMedicaid
KSCS5640Medicare ID - Type UnspecifiedRRMEDICARE PROVIDER #
KS014722Medicare ID - Type UnspecifiedPROVIDER NUMBER