Healthcare Provider Details

I. General information

NPI: 1518687052
Provider Name (Legal Business Name): MICHAEL DAVID BLAIR PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 OAK RIDGE TURNPIKE
OAK RIDGE TN
37830-7164
US

IV. Provider business mailing address

564 OAK RIDGE TPKE
OAK RIDGE TN
37830-7164
US

V. Phone/Fax

Practice location:
  • Phone: 865-213-2744
  • Fax: 865-315-7033
Mailing address:
  • Phone: 865-213-2744
  • Fax: 865-315-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14357
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: