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NPI Code Detail

MEDICARE: FRETCHE BLAIR

MEDICARE: FRETCHE BLAIR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist22CO

General Provider Information

NPI Number : 1245578681
Entity Type Code : Individual
Provider Name (Legal Business Name) : FRETCHE BLAIR
Provider Business Mailing Address
First Line : 1238 PTARMIGAN DR
Second Line :
City : LONGMONT
State : CO
Zip : 80504-2263
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11169 E I25 FRONTAGE RD STE C
Second Line :
City : FIRESTONE
State : CO
Zip : 80504-5211
Country : US
Telephone Number : 720-600-0370
Fax Number : 720-600-0374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2013
Last Update Date : 08/25/2025

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Directions to “ FRETCHE BLAIR ” Practice Location

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