Provider Demographics
NPI:1730784281
Name:BLOOM PHYSICAL THERAPY & WELLNESS PLLC
Entity type:Organization
Organization Name:BLOOM PHYSICAL THERAPY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNION
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LMT, CLT
Authorized Official - Phone:512-468-4454
Mailing Address - Street 1:138 TX-46
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:512-468-4454
Mailing Address - Fax:210-519-4053
Practice Address - Street 1:138 TX-46
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:512-468-4454
Practice Address - Fax:210-519-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy