Provider Demographics
NPI:1861007841
Name:BLUME, BRANDEN SHANE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:SHANE
Last Name:BLUME
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6312
Mailing Address - Country:US
Mailing Address - Phone:479-871-5330
Mailing Address - Fax:
Practice Address - Street 1:5300 S SOUTHERN HILLS CT # 200
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-3500
Practice Address - Country:US
Practice Address - Phone:479-636-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT48492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic