Provider Demographics
NPI:1407141617
Name:BLOOM, JAYME BETH (DPT)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:BETH
Last Name:BLOOM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:BETH
Other - Last Name:SHIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1836 GREENE TREE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1836 GREENE TREE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1381
Practice Address - Country:US
Practice Address - Phone:410-486-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist