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General NPI Number Information
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NPI Number | 1104862754
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Entity Type | Individual
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Provider Name | SUSAN SLOCUM BLAIR PT
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 857 CENTER CT
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City | SHOREWOOD
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State | IL
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Zip | 60431-8520
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Country | US
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Telephone | 815-730-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 THACKERY CT
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City | NAPERVILLE
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State | IL
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Zip | 60564-3175
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Country | US
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Telephone | 630-904-8152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | IL
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