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General NPI Number Information
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NPI Number | 1144195645
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Entity Type | Organization
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Legal Business Name | NOVA BLOOM THERAPY LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 7420 SW 39TH ST
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City | MIAMI
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State | FL
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Zip | 33155-6620
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Country | US
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Telephone | 786-591-9693
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Fax |
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Provider Business Mailing Address
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Address Line | 7420 SW 39TH ST
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City | MIAMI
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State | FL
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Zip | 33155-6620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MGR
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Name | AMANDA DIAZ
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Credential |
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Telephone | 786-591-9693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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