Provider Demographics
NPI:1356392898
Name:GREENFIELD -BLAU, FELICIA B (PT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:B
Last Name:GREENFIELD -BLAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3061
Mailing Address - Country:US
Mailing Address - Phone:215-870-4944
Mailing Address - Fax:
Practice Address - Street 1:1349 W CHELTENHAM AVE STE 201
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3141
Practice Address - Country:US
Practice Address - Phone:215-782-1612
Practice Address - Fax:215-782-1620
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007649L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103336OtherBC/BS
PA102662008 001Medicaid
PA103336OtherBC/BS