Healthcare Provider Details

I. General information

NPI: 1508722877
Provider Name (Legal Business Name): DAVID JOE BLAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E MOORE AVE
GILBERT AZ
85234-2452
US

IV. Provider business mailing address

444 E MOORE AVE
GILBERT AZ
85234-2452
US

V. Phone/Fax

Practice location:
  • Phone: 602-558-3716
  • Fax:
Mailing address:
  • Phone: 602-558-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-50563
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: