Individual
DR. EDWARD J BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
6640 PARKDALE PL STE T, INDIANAPOLIS, IN 46254-5619
(317) 808-7070
(317) 808-7073
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258
(586) 350-2644
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010015A
IN
225100000X
Physical Therapist
11414
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11414
PHYSICAL THERAPIST LICENSE
CO
Enumeration date
09/06/2011
Last updated
09/10/2021
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