Organization
BLOOM OF JONESBORO, LLC
Active
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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