Provider Demographics
NPI:1699090787
Name:BLAU, ANDREA GOLDBLUM (PT)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:GOLDBLUM
Last Name:BLAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:GOLDBLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1500 LOCUST ST
Mailing Address - Street 2:APT. 2911
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4329
Mailing Address - Country:US
Mailing Address - Phone:412-414-1503
Mailing Address - Fax:
Practice Address - Street 1:1500 LOCUST ST
Practice Address - Street 2:APT. 2911
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4329
Practice Address - Country:US
Practice Address - Phone:412-414-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist