Provider Demographics
NPI:1578570669
Name:BLOOMER, MELISSA SUE (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:BLOOMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3022 MAGNOLIA BND
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8295
Mailing Address - Country:US
Mailing Address - Phone:434-989-5520
Mailing Address - Fax:
Practice Address - Street 1:3022 MAGNOLIA BND
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8295
Practice Address - Country:US
Practice Address - Phone:434-989-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009163A57Medicare ID - Type Unspecified