Healthcare Provider Details

I. General information

NPI: 1356743777
Provider Name (Legal Business Name): GREGORY BLOSSER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 FRANKLIN ST
WEYERS CAVE VA
24486-2347
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 540-234-8800
  • Fax: 540-234-8939
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: