Provider Demographics
NPI:1679933469
Name:BLUMBERG, SUKHPRIT MANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SUKHPRIT
Middle Name:MANN
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SUKHPRIT
Other - Middle Name:KAUR
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:17070 CALLE TREVINO UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-8804
Mailing Address - Country:US
Mailing Address - Phone:408-466-9908
Mailing Address - Fax:
Practice Address - Street 1:17070 CALLE TREVINO UNIT 11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-8804
Practice Address - Country:US
Practice Address - Phone:408-466-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist