Provider Demographics
NPI:1003679507
Name:BLOSSOM THERAPY CENTER LLC
Entity type:Organization
Organization Name:BLOSSOM THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIUSZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SZCZESNOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-839-2268
Mailing Address - Street 1:6612 WEAVER CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-2797
Mailing Address - Country:US
Mailing Address - Phone:443-839-2268
Mailing Address - Fax:
Practice Address - Street 1:7411 RIGGS RD STE 308
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-4246
Practice Address - Country:US
Practice Address - Phone:443-839-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-03-05
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