Healthcare Provider Details

I. General information

NPI: 1760405799
Provider Name (Legal Business Name): KRISTY ANN BLAIR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WALL ST SUITE 100
WEST LONG BRANCH NJ
07764-1181
US

IV. Provider business mailing address

2209 KILKARE PKWY
POINT PLEASANT BORO NJ
08742-3818
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-8556
  • Fax: 732-222-8663
Mailing address:
  • Phone: 732-892-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01032300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: