MEDICARE: LITTLE BLOOM PEDIATRIC THERAPY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	225XP0200X	Pediatric Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598605925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE BLOOM PEDIATRIC THERAPY CENTER

Provider Business Mailing Address
First Line	:	10900 E TAYLOR RD APT 220
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-4081
Country	:	US
Telephone Number	:	228-609-9160
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 E TAYLOR RD APT 220
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-4081
Country	:	US
Telephone Number	:	228-609-9160
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JASIA WALKER
Credential	:
Telephone Number	:	229-609-9160

Provider Enumeration Date	:	03/28/2026
Last Update Date	:	03/28/2026

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Directions to “LITTLE BLOOM PEDIATRIC THERAPY CENTER ” Practice Location

Language	Start Address	Practice Location

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