Healthcare Provider Details

I. General information

NPI: 1437088929
Provider Name (Legal Business Name): ASHIRA BLOOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 TAYLOR DR
FOLCROFT PA
19032-1623
US

IV. Provider business mailing address

1119 TAYLOR DR
FOLCROFT PA
19032-1623
US

V. Phone/Fax

Practice location:
  • Phone: 484-714-1772
  • Fax: 484-714-1772
Mailing address:
  • Phone: 484-714-1772
  • Fax: 484-714-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MARGARET ANN DEVORE-CRADDOCK
Title or Position: OWNER
Credential: DEVORE-CRADDOCK
Phone: 484-714-1772