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Individual

ERNEST RANDY BLOOM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
1930 HIGHLAND AVENUE SUITE A, AUGUSTA, GA 30904-7803
(706) 481-9105
(706) 481-9107
Mailing address
1930 HIGHLAND AVE STE A, AUGUSTA, GA 30904-7803
(706) 481-9105
(706) 481-9107

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002060
GA
225200000X
Physical Therapy Assistant
TE007060
PA

Other

Enumeration date
03/27/2007
Last updated
07/21/2022
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