Basic Information
| Provider Information | |||||||||
| NPI: | 1366655862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUMENTHAL | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | NORMANDY | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 N BONHILL RD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900492325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104714002 | ||||||||
| FaxNumber: | 3104714002 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106568600 | ||||||||
| FaxNumber: | 3106568606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 9054 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.