Provider Demographics
NPI:1952835480
Name:SMB THERAPY
Entity Type:Organization
Organization Name:SMB THERAPY
Other - Org Name:SUSAN MURRAY-BLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:MURRAY-BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, RMT
Authorized Official - Phone:774-402-0552
Mailing Address - Street 1:19 PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-5117
Mailing Address - Country:US
Mailing Address - Phone:774-402-0552
Mailing Address - Fax:
Practice Address - Street 1:19 PRINCE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5117
Practice Address - Country:US
Practice Address - Phone:774-402-0552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17540261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy