Leesa Foster Blum, M.ED.

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

Practice address

10105 Crooked Creek CT
Fairfax Station, VA 22039-2955

Phone

(703) 477-5743

NPI assigned

Jan 16, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1386359396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10105 CROOKED CREEK CT",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220392955",
            "telephone_number": "703-477-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10105 CROOKED CREEK CT",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220392955",
            "telephone_number": "703-477-5743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "LEESA",
        "middle_name": "FOSTER",
        "name_prefix": "Mrs.",
        "credential": "M.ED.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Y00000X",
            "taxonomy_group": "",
            "desc": "Clinical Exercise Physiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fairfax Station, VA
• Clinical Exercise Physiologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.