Provider Demographics
NPI:1730480666
Name:BLOOM, ERIC JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 S ELLSWORTH RD
Mailing Address - Street 2:BUILDING 4, SUITE 128
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2160
Mailing Address - Country:US
Mailing Address - Phone:480-357-6500
Mailing Address - Fax:480-357-6515
Practice Address - Street 1:3035 S ELLSWORTH RD
Practice Address - Street 2:BUILDING 4, SUITE 128
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2160
Practice Address - Country:US
Practice Address - Phone:480-357-6500
Practice Address - Fax:480-357-6515
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist