Healthcare Provider Details

I. General information

NPI: 1215954227
Provider Name (Legal Business Name): THOMAS EDWARD BLOUNT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARK PL SUITE 2
SHIPPENSBURG PA
17257-9806
US

IV. Provider business mailing address

20 PARK PL SUITE 2
SHIPPENSBURG PA
17257-9806
US

V. Phone/Fax

Practice location:
  • Phone: 717-477-8030
  • Fax: 717-477-8040
Mailing address:
  • Phone: 717-477-8030
  • Fax: 717-477-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21649
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017913
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: