Provider Demographics
NPI:1710296231
Name:BLATT, BRIAN J (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:BLATT
Suffix:
Gender:M
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:740 MARNE HWY STE 203
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3127
Practice Address - Country:US
Practice Address - Phone:856-914-1400
Practice Address - Fax:856-914-1444
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020699225100000X
NJ40QA01378400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist