Provider Demographics
NPI:1982245411
Name:BLOOM PHYSICAL THERAPY AND WOUND CARE LLC
Entity Type:Organization
Organization Name:BLOOM PHYSICAL THERAPY AND WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, CWS
Authorized Official - Phone:215-850-6323
Mailing Address - Street 1:747 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3504
Mailing Address - Country:US
Mailing Address - Phone:215-850-6323
Mailing Address - Fax:
Practice Address - Street 1:747 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3504
Practice Address - Country:US
Practice Address - Phone:215-850-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No252Y00000XAgenciesEarly Intervention Provider Agency