MEDICARE: SAMUEL BLUM 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	15527	WI

General Provider Information

NPI Number	:	1760055081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BLUM PT

Provider Business Mailing Address
First Line	:	105 CLARMAR DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2675
Country	:	US
Telephone Number	:	608-318-5929
Fax Number	:	608-318-5922

Provider Business Practice Location Address
First Line	:	6710 UNIVERSITY AVE
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-2764
Country	:	US
Telephone Number	:	608-820-1300
Fax Number	:	608-836-9672

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/16/2024

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Directions to “ SAMUEL BLUM PT” Practice Location

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