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General NPI Number Information
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NPI Number | 1720883473
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Entity Type | Organization
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Legal Business Name | BOLTING TO BLOOM INC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 888-240-2099
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Fax | 813-423-6533
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 888-240-2099
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Fax | 813-423-6533
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. MELVIN PORCHEA JR.
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Credential | BACB-RBT,
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Telephone | 888-240-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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