Healthcare Provider Details

I. General information

NPI: 1205895711
Provider Name (Legal Business Name): BLASER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NORTH HILL DR
WARRENTON VA
20186-2610
US

IV. Provider business mailing address

40 NORTH HILL DR
WARRENTON VA
20186-2610
US

V. Phone/Fax

Practice location:
  • Phone: 540-341-1922
  • Fax: 540-341-1923
Mailing address:
  • Phone: 540-341-1922
  • Fax: 540-341-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KENDAL BLASER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 540-341-1922