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General NPI Number Information
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NPI Number | 1467268490
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Entity Type | Organization
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Legal Business Name | BLOOM THERAPY CENTER
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 1103 WALNUT ST
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City | DERIDDER
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State | LA
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Zip | 70634-2731
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Country | US
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Telephone | 337-202-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 WALNUT ST
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City | DERIDDER
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State | LA
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Zip | 70634-2731
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Country | US
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Telephone | 337-202-0568
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Fax |
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Authorized Official
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Title or Position | MANAGER, OTR
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Name | SARAH BRACK
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Credential | MOT
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Telephone | 337-202-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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