MEDICARE: FULL BLOOM

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	:	1316606759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL BLOOM

Provider Business Mailing Address
First Line	:	301 HIGGINS AVE STE 106
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3006
Country	:	US
Telephone Number	:	865-268-9716
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 HIGGINS AVE STE 106
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3006
Country	:	US
Telephone Number	:	865-268-9716
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY, OWNER
Name	:	DR. JANINE LORRAINE BOBBY
Credential	:	PT, DPT
Telephone Number	:	865-268-9716

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	02/15/2022

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