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General NPI Number Information
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NPI Number | 1801781489
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Entity Type | Organization
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Legal Business Name | BLOSSOM & GROW PEDIATRIC THERAPY INC.
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 2736 UNIVERSITY BLVD W STE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2170
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Country | US
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Telephone | 352-422-1126
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Fax | 904-606-0112
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Provider Business Mailing Address
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Address Line | 2736 UNIVERSITY BLVD W STE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2170
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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 | DIRECTOR
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Name | JENNIFER NITZ
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Credential | OTR/L
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Telephone | 352-422-1126
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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 | 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 #3
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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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