Healthcare Provider Details

I. General information

NPI: 1205379450
Provider Name (Legal Business Name): BLAIR SWEENEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 WALLER MILL RD
WILLIAMSBURG VA
23185-3000
US

IV. Provider business mailing address

103 OLD CART RD
WILLIAMSBURG VA
23188-7810
US

V. Phone/Fax

Practice location:
  • Phone: 757-879-8934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305212648
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: