Provider Demographics
NPI:1750018958
Name:BLUME, GRANT RICHARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:RICHARD
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 1:410 BLOEDEL RESERVE WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-7324
Mailing Address - Country:US
Mailing Address - Phone:706-830-1816
Mailing Address - Fax:
Practice Address - Street 1:3104 SKINNER MILL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1968
Practice Address - Country:US
Practice Address - Phone:706-522-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist