MEDICARE: MR. JEFFREY THOMAS 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	PT 20627	FL

General Provider Information

NPI Number	:	1760578926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY THOMAS BLUM PT

Provider Business Mailing Address
First Line	:	15813 AUTUMN GLEN AVE
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34714-6111
Country	:	US
Telephone Number	:	407-361-6452
Fax Number	:	407-939-2310

Provider Business Practice Location Address
First Line	:	700 VICTORY WAY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-4100
Country	:	US
Telephone Number	:	407-939-2316
Fax Number	:	407-939-2310

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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