MEDICARE: BLOOM & GROW THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1932041522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM & GROW THERAPY LLC

Provider Business Mailing Address
First Line	:	3637 DEL PRADO BLVD S STE 305
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7199
Country	:	US
Telephone Number	:	239-218-6396
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 DEL PRADO BLVD S STE 305
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7199
Country	:	US
Telephone Number	:	239-218-6396
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IDELMYS DIAZ
Credential	:
Telephone Number	:	239-218-6396

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “BLOOM & GROW THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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