Provider Demographics
NPI:1639295751
Name:BLUME, SUSAN K (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:BLUME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 KATHY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4202
Mailing Address - Country:US
Mailing Address - Phone:215-938-4578
Mailing Address - Fax:
Practice Address - Street 1:9896 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-5202
Practice Address - Country:US
Practice Address - Phone:215-934-3047
Practice Address - Fax:215-969-3138
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005142L225100000X
NJ40QA00307100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist