Provider Demographics
NPI:1730202730
Name:BLIEDEN, AMY HOPE (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:HOPE
Last Name:BLIEDEN
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 1:11100 ACAMA ST UNIT 16
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3074
Mailing Address - Country:US
Mailing Address - Phone:818-506-6248
Mailing Address - Fax:818-508-5504
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-7469
Practice Address - Fax:818-832-7249
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist