Provider Demographics
NPI:1114818002
Name:BLOOM PEDIATRIC THERAPY, PLLC
Entity type:Organization
Organization Name:BLOOM PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDUC
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:203-417-5864
Mailing Address - Street 1:43 MAPLE VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2125
Mailing Address - Country:US
Mailing Address - Phone:203-417-5864
Mailing Address - Fax:
Practice Address - Street 1:17 COMMONS DR UNIT 6
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759
Practice Address - Country:US
Practice Address - Phone:203-417-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy