Individual ProviderCarol B. BloomPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2214 Main Street, La Crosse, WI 54601-3918(608) 784-6970PECOS EnrollmentBased on the most recent information from CMS, provider Carol B. Bloom does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1366610099Provider TypeIndividualFull NameBloom, Carol B.TitleMs.CredentialPTGenderFemaleSole ProprietorYesEnumeration Date2/15/2008Last Updated2/15/2008Contact InformationPractice LocationPractice Address2214 Main Street, La Crosse, WI 54601-3918Phone(608) 784-6970Fax(608) 784-6970Mailing LocationMailing Address2214 Main St, La Crosse, WI 54601-3918Phone(608) 784-6970Fax(608) 784-6970Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1231-024WisconsinProvider IdentifiersIDDescriptionIssuerID40062700DescriptionMedicaidIssuerUnlistedWisconsin