MEDICARE: KATHY J BLAIR PT

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
1	225100000X	Physical Therapist	15216	MT
2	225100000X	Physical Therapist	496	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649323460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY J BLAIR PT

Provider Business Mailing Address
First Line	:	1541 CENTENNIAL CT
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-7304
Country	:	US
Telephone Number	:	307-235-3910
Fax Number	:	307-266-2891

Provider Business Practice Location Address
First Line	:	1541 CENTENNIAL CT
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-7304
Country	:	US
Telephone Number	:	307-235-3910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	04/27/2021

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