Provider Demographics
NPI:1508620535
Name:BLOOM SPA THERAPY LLC
Entity Type:Organization
Organization Name:BLOOM SPA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARGUELLO FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-306-6974
Mailing Address - Street 1:208 AIPORT PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 AIPORT PLAZA BLVD, SALONS BY JC
Practice Address - Street 2:SUITE 11
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:347-306-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty