Provider Demographics
NPI:1013726975
Name:BLOOM, BRAEDAN (PT,DPT)
Entity type:Individual
Prefix:
First Name:BRAEDAN
Middle Name:
Last Name:BLOOM
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791217
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1217
Mailing Address - Country:US
Mailing Address - Phone:301-932-4786
Mailing Address - Fax:301-932-4789
Practice Address - Street 1:60 MARKET ST STE 206
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6559
Practice Address - Country:US
Practice Address - Phone:301-990-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist