Individual
ELIZABETH AV BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
621 SCIENCE DR, MADISON, WI 53711-1074
(608) 265-3207
Mailing address
621 SCIENCE DR, MADISON, WI 53711-1074
(608) 265-3207
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12154
WI
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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