MEDICARE: ELLEN BLOOME P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	36569	CA
2	2251G0304X	Geriatric Physical Therapist	6659	FL
3	225100000X	Physical Therapist	6659	FL

General Provider Information

NPI Number	:	1972612513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN BLOOME P.T.

Provider Business Mailing Address
First Line	:	7539 DIAMOND POINTE CIR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3344
Country	:	US
Telephone Number	:	561-558-3316
Fax Number	:

Provider Business Practice Location Address
First Line	:	7539 DIAMOND POINTE CIR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3344
Country	:	US
Telephone Number	:	561-558-3316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	03/10/2022

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Directions to “ ELLEN BLOOME P.T.” Practice Location

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