Provider Demographics
NPI:1215954227
Name:BLOUNT, THOMAS EDWARD (DPT)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARK PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9806
Mailing Address - Country:US
Mailing Address - Phone:717-477-8030
Mailing Address - Fax:717-477-8040
Practice Address - Street 1:20 PARK PL
Practice Address - Street 2:SUITE 2
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9806
Practice Address - Country:US
Practice Address - Phone:717-477-8030
Practice Address - Fax:717-477-8040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21649225100000X
PAPT017913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023209970001Medicaid
PA108733V9XMedicare PIN
MD995MN086Medicare ID - Type Unspecified