Provider Demographics
NPI:1386359396
Name:BLUM, LEESA FOSTER (MED)
Entity type:Individual
Prefix:MRS
First Name:LEESA
Middle Name:FOSTER
Last Name:BLUM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:10105 CROOKED CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2955
Mailing Address - Country:US
Mailing Address - Phone:703-477-5743
Mailing Address - Fax:
Practice Address - Street 1:10105 CROOKED CREEK CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-2955
Practice Address - Country:US
Practice Address - Phone:703-477-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist