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General NPI Number Information
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NPI Number | 1053783951
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Entity Type | Individual
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Provider Name | ELYSE BLOOMFIELD DPT
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Gender | Female
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 2324 EASTLAKE AVE E STE 100
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City | SEATTLE
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State | WA
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Zip | 98102-6532
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Country | US
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Telephone | 617-281-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 FRANKLIN AVE E APT 306
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City | SEATTLE
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State | WA
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Zip | 98102-3458
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Country | US
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Telephone | 617-281-3340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60569001
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License Number State | WA
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