Provider Demographics
NPI:1063799799
Name:BLOOM, JARED WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:WILLIAM
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 HOOVER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8133
Mailing Address - Country:US
Mailing Address - Phone:614-871-3832
Mailing Address - Fax:614-871-7225
Practice Address - Street 1:6024 HOOVER RD
Practice Address - Street 2:SUITE D
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8133
Practice Address - Country:US
Practice Address - Phone:614-871-3832
Practice Address - Fax:614-871-7225
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist