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Organization

BLOOM OF JONESBORO, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOCELYN JOHNSON (INCORPORATOR)
(870) 919-3141
Entity
Organization

Contact information

Practice address
1007 WINDOVER RD STE A, JONESBORO, AR 72401-6009
(870) 919-3141
(870) 931-6599
Mailing address
188 COUNTY ROAD 133, BONO, AR 72416-8084
(870) 919-3141
(870) 520-6055

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
APPLYING
AR
Enumeration date
07/30/2018
Last updated
07/30/2018
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