Blossom Physical Therapy and Wellness LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BLOSSOM PHYSICAL THERAPY AND WELLNESS LLC

Practice address

11676 Perry Hwy Ste 2309
Wexford, PA 15090-7200

Phone

(216) 816-5212

NPI assigned

Oct 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Milena Luchetta Da Costa, DPTNPI 1972076867

Title

Physical Therapist

Phone

(216) 816-5212

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Milena Luchetta Da Costa, PT

  • Physical Therapist
  • Johns Creek, GA
  • NPI 1972076867

  PA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1497573869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9911 LE GRAND DR",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150907012",
            "telephone_number": "216-816-5212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11676 PERRY HWY STE 2309",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150907200",
            "telephone_number": "216-816-5212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM PHYSICAL THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "LUCHETTA DA COSTA",
        "authorized_official_first_name": "MILENA",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "216-816-5212",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Blanco, LPC
• Carolyn Bland
• Elizabeth Blasik
• Sandra Alane Block, LCSW
• Shanna M Bloomgren, PTA
• Boivin Family Chiropractic PLLC
• Randal Robert Boivin, DC
• Leyna Bonanno, LPC
• Madison Book, OTR/L
• David Boone, MS/OTRL

• Physical Therapist in Wexford, PA
• Providers in Wexford, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.