Healthcare Provider Details

I. General information

NPI: 1972612513
Provider Name (Legal Business Name): ELLEN BLOOME P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7539 DIAMOND POINTE CIR
DELRAY BEACH FL
33446-3344
US

IV. Provider business mailing address

7539 DIAMOND POINTE CIR
DELRAY BEACH FL
33446-3344
US

V. Phone/Fax

Practice location:
  • Phone: 561-558-3316
  • Fax:
Mailing address:
  • Phone: 561-558-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number6659
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: