Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT027949 | PA |
NPI | 1013565936 |
---|---|
Provider Name | Devon Blitzer |
First Address | King Of Prussia, PA 19406-1495 |
Second Address | Pottstown, PA 19465-9649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |