MEDICARE: BLOOM BIZ WELLNESS LLC

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1619787405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM BIZ WELLNESS LLC

Provider Business Mailing Address
First Line	:	13812 N US HIGHWAY 183 STE B4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13812 N US HIGHWAY 183 STE B4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-1238
Country	:	US
Telephone Number	:	512-541-6605
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAN LI
Credential	:	LMT
Telephone Number	:	512-740-6359

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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Directions to “BLOOM BIZ WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

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