Provider Demographics
NPI:1164152872
Name:BLOSSOM PEDIATRIC THERAPY PARTNERS
Entity Type:Organization
Organization Name:BLOSSOM PEDIATRIC THERAPY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY LONGVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:216-401-6698
Mailing Address - Street 1:411 WOLF LEDGES PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 WOLF LEDGES PKWY
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1028
Practice Address - Country:US
Practice Address - Phone:216-401-6698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty