Provider Demographics
NPI:1306910443
Name:BLODGETT, JULIE RENEE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RENEE
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:RENEE
Other - Last Name:SUCHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3751 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846
Mailing Address - Country:US
Mailing Address - Phone:616-522-0066
Mailing Address - Fax:616-527-1667
Practice Address - Street 1:3751 S STATE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846
Practice Address - Country:US
Practice Address - Phone:616-522-0066
Practice Address - Fax:616-527-1667
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist