MEDICARE: KELLY BLOCHLINGER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01939600	NJ

General Provider Information

NPI Number	:	1093436651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BLOCHLINGER PT

Provider Business Mailing Address
First Line	:	159 BELVIDERE AVE
Second Line	:
City	:	FANWOOD
State	:	NJ
Zip	:	07023-1601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 WASHINGTON VALLEY RD
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2026
Country	:	US
Telephone Number	:	201-401-0702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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Directions to “ KELLY BLOCHLINGER PT” Practice Location

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