Healthcare Provider Details

I. General information

NPI: 1134038631
Provider Name (Legal Business Name): BLOOM NEURO PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24010 CLYDE COCKERHAM LN
DENHAM SPRINGS LA
70726-7299
US

IV. Provider business mailing address

24010 CLYDE COCKERHAM LN
DENHAM SPRINGS LA
70726-7299
US

V. Phone/Fax

Practice location:
  • Phone: 225-485-4635
  • Fax:
Mailing address:
  • Phone: 225-485-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY STEARS BOYLE
Title or Position: OWNER
Credential: PT, DPT, NCS
Phone: 225-485-4635