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General NPI Number Information
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NPI Number | 1609234491
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Entity Type | Organization
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Legal Business Name | BLOOM WOMEN'S PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 730 WILLEY LN
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-5518
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Country | US
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Telephone | 424-253-8509
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Fax |
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Provider Business Mailing Address
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Address Line | 730 WILLEY LN
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-5518
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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 | FOUNDER/DIRECTOR/PHYSICAL THERAPIST
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Name | DR. GRACE ABRUZZO
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Credential | D.P.T.
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Telephone | 424-253-8509
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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 | 42109
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License Number State | CA
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