Provider Demographics
NPI:1750810321
Name:BLOOM, CIERRA (ATC)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 DEER RD SE
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-9363
Mailing Address - Country:US
Mailing Address - Phone:330-401-4702
Mailing Address - Fax:
Practice Address - Street 1:6645 DEER RD SE
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-9363
Practice Address - Country:US
Practice Address - Phone:330-401-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000028647Other22 (RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS)