Shantel Blume, DPT, CLT
Individual provider Active NPI Physical Therapist · Gallup, NM
NPI 1073045282 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1073045282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2305208078 (VA)
- Practice address
- 516 E Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1000
- NPI assigned
- Mar 28, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305208078 | VA | Yes |
Addresses
Primary practice location
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1000
Other providers in Gallup, NM
- Kyle Steven Blankenship
- Rachel Jane Blizzard
- Barrie Bloom
- Christine Blosser
- Blue Cedar Wellness LLC
- Sandra L Blythe
- Alicia Bobelu
- Denice Bobelu
- Megan Bodemuller
- Cecelia Bodiford
All providers in Gallup, NM · Physical Therapist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.