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General NPI Number Information
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NPI Number | 1497124705
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Entity Type | Organization
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Legal Business Name | BLOOM WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 9798 COORS BLVD NW BLDG C SUITE 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6131
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Country | US
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Telephone | 505-639-5147
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Fax | 505-639-4153
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Provider Business Mailing Address
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Address Line | 9798 COORS BLVD NW BLDG C SUITE 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6131
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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 | PRESIDENT/OWNER
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Name | HEATHER JONES
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Credential | DOM
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Telephone | 505-400-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | 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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1057
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License Number State | NM
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