Provider Demographics
NPI:1356504310
Name:SAMUEL, BLESSEN (PT)
Entity Type:Individual
Prefix:MR
First Name:BLESSEN
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E JUDITH ANN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2106
Mailing Address - Country:US
Mailing Address - Phone:713-391-7000
Mailing Address - Fax:
Practice Address - Street 1:439 S MAIN ST
Practice Address - Street 2:SUITE NO 160
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2106
Practice Address - Country:US
Practice Address - Phone:713-391-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist