Provider Demographics
NPI:1871622852
Name:BLATT, STUART DAVID (PHD, PT)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:DAVID
Last Name:BLATT
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 WHITE BIRCH TRL
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-9502
Mailing Address - Country:US
Mailing Address - Phone:810-923-8970
Mailing Address - Fax:
Practice Address - Street 1:2404 WHITE BIRCH TRL
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-9502
Practice Address - Country:US
Practice Address - Phone:810-923-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist