Provider Demographics
NPI:1053783951
Name:BLOOMFIELD, ELYSE (DPT)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 FRANKLIN AVE E APT 306
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3458
Mailing Address - Country:US
Mailing Address - Phone:617-281-3340
Mailing Address - Fax:
Practice Address - Street 1:2324 EASTLAKE AVE E STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-6532
Practice Address - Country:US
Practice Address - Phone:617-281-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60569001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60569001OtherPT LICENSE NUMBER