Provider Demographics
NPI:1093304131
Name:FULL BLOOM WELLNESS, LLC
Entity Type:Organization
Organization Name:FULL BLOOM WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:412-401-3118
Mailing Address - Street 1:230 CRESCENT WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3469
Mailing Address - Country:US
Mailing Address - Phone:412-401-3118
Mailing Address - Fax:
Practice Address - Street 1:230 CRESCENT WAY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3469
Practice Address - Country:US
Practice Address - Phone:412-401-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy