MEDICARE: CACTUS BLOOM THERAPEUTICS, 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
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1811713316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CACTUS BLOOM THERAPEUTICS, LLC

Provider Business Mailing Address
First Line	:	1203 COLORADO AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-4630
Country	:	US
Telephone Number	:	970-609-9771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 COLORADO AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-4630
Country	:	US
Telephone Number	:	970-609-9771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA MARCHESE
Credential	:	DPT, LMT
Telephone Number	:	970-609-9771

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	12/31/2024

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