Provider Demographics
NPI:1467561175
Name:BLOEBAUM, DARREN JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:JOSEPH
Last Name:BLOEBAUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 WESTSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3035
Mailing Address - Country:US
Mailing Address - Phone:813-785-5930
Mailing Address - Fax:
Practice Address - Street 1:3488 E LAKE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2404
Practice Address - Country:US
Practice Address - Phone:727-771-7377
Practice Address - Fax:717-412-9851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist