Provider Demographics
NPI:1679088728
Name:BLUMBERG, CHRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MORRISON MOORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1588
Mailing Address - Country:US
Mailing Address - Phone:706-864-9192
Mailing Address - Fax:706-864-6306
Practice Address - Street 1:95 MORRISON MOORE PKWY W
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1588
Practice Address - Country:US
Practice Address - Phone:706-864-9192
Practice Address - Fax:706-864-6306
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant