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General NPI Number Information
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NPI Number | 1598605925
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Entity Type | Organization
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Legal Business Name | LITTLE BLOOM PEDIATRIC THERAPY CENTER
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Dates
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Enumeration Date | 03/28/2026
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Last Update Date | 03/28/2026
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Provider Practice Location Address
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Address Line | 10900 E TAYLOR RD APT 220
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City | GULFPORT
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State | MS
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Zip | 39503-4081
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Country | US
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Telephone | 228-609-9160
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Fax |
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Provider Business Mailing Address
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Address Line | 10900 E TAYLOR RD APT 220
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City | GULFPORT
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State | MS
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Zip | 39503-4081
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Country | US
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Telephone | 228-609-9160
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JASIA WALKER
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Credential |
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Telephone | 229-609-9160
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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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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 | 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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