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General NPI Number Information
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NPI Number | 1619787405
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Entity Type | Organization
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Legal Business Name | BLOOM BIZ WELLNESS LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 13812 N US HIGHWAY 183 STE B4
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City | AUSTIN
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State | TX
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Zip | 78750-1238
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Country | US
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Telephone | 512-541-6605
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Fax |
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Provider Business Mailing Address
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Address Line | 13812 N US HIGHWAY 183 STE B4
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City | AUSTIN
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State | TX
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Zip | 78750-1238
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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
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Name | NAN LI
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Credential | LMT
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Telephone | 512-740-6359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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