Provider Demographics
NPI:1043847353
Name:BLUM, DARCY SUZANNE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:SUZANNE
Last Name:BLUM
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:SUZANNE
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 TUNIS ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3648
Mailing Address - Country:US
Mailing Address - Phone:850-377-2232
Mailing Address - Fax:
Practice Address - Street 1:4551 N DAVIS HWY STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2782
Practice Address - Country:US
Practice Address - Phone:850-494-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL62632255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer