Provider Demographics
NPI:1982138418
Name:MURRAY-BLAKE, SUSAN AMANDA (PT, RMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMANDA
Last Name:MURRAY-BLAKE
Suffix:
Gender:F
Credentials:PT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist