Provider Demographics
NPI:1578224887
Name:BLUME, CECILY ANN (DPT)
Entity type:Individual
Prefix:
First Name:CECILY
Middle Name:ANN
Last Name:BLUME
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:ANN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:757 E US HIGHWAY 80 STE 160
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8732
Mailing Address - Country:US
Mailing Address - Phone:469-602-5283
Mailing Address - Fax:469-602-5683
Practice Address - Street 1:757 E US HIGHWAY 80 STE 160
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8732
Practice Address - Country:US
Practice Address - Phone:469-393-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist