Provider Demographics
NPI:1396840492
Name:BLUMAN, ELAINA (PT)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:BLUMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13144 BALFOUR AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1701
Mailing Address - Country:US
Mailing Address - Phone:608-554-0054
Mailing Address - Fax:
Practice Address - Street 1:13144 BALFOUR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1701
Practice Address - Country:US
Practice Address - Phone:608-554-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10503-024225100000X
MI5501015676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40468000Medicaid