Provider Demographics
NPI:1154105484
Name:BLOCH, ALEXANDER EDWARD
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:EDWARD
Last Name:BLOCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:EDWARD
Other - Last Name:BLOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:5425 JONESTOWN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4086
Mailing Address - Country:US
Mailing Address - Phone:179-019-4877
Mailing Address - Fax:717-901-9488
Practice Address - Street 1:5425 JONESTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4086
Practice Address - Country:US
Practice Address - Phone:179-019-4877
Practice Address - Fax:717-901-9488
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist