# MAX BLOOM RPT PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316197361
- **Authorized official:** MRS. DENISE SHARON WHITE (GENERAL MANAGER)
- **Authorized official phone:** (410) 788-0505

## Contact information

- **Practice address:** 583 FREDERICK RD, SUITE 4, BALTIMORE, MD 21228-4697
- **Practice address phone:** (410) 788-0505
- **Mailing address:** 583 FREDERICK RD, SUITE 4, BALTIMORE, MD 21228-4697
- **Mailing address phone:** (410) 788-0505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 10280 | MD | Yes |

## Other

- **Enumeration date:** 09/26/2008
- **Last updated:** 09/26/2008