MEDICARE: BLOOM PHYSICAL THERAPY & WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1174223002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM PHYSICAL THERAPY & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	4086 N COUNTRY CLUB RD STE 2
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-5580
Country	:	US
Telephone Number	:	580-967-1355
Fax Number	:

Provider Business Practice Location Address
First Line	:	4086 COUNTRY CLUB RD STE 2
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-5580
Country	:	US
Telephone Number	:	809-671-3555
Fax Number	:

Authorized Official
Title or Position	:	OWNER & PHYSICAL THERAPIST
Name	:	JORDAN CODY
Credential	:	PT, DPT
Telephone Number	:	580-967-1355

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	06/18/2026

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