Healthcare Provider Details

I. General information

NPI: 1417866971
Provider Name (Legal Business Name): ANGELA BLAIR LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17001 HOLLAND RD
BROOKPARK OH
44142-3523
US

IV. Provider business mailing address

36774 S PARK DR
AVON OH
44011-3513
US

V. Phone/Fax

Practice location:
  • Phone: 216-898-8307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA007207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: