Healthcare Provider Details

I. General information

NPI: 1437020252
Provider Name (Legal Business Name): BLOOM YOGA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OAKWOOD BLVD STE 163
HOLLYWOOD FL
33020-1961
US

IV. Provider business mailing address

2517 N 28TH AVE
HOLLYWOOD FL
33020-1815
US

V. Phone/Fax

Practice location:
  • Phone: 954-663-2692
  • Fax:
Mailing address:
  • Phone: 954-663-2692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA DELUCA
Title or Position: OWNER
Credential: MS, C-IAYT, ERYT-500
Phone: 954-663-2692