Healthcare Provider Details

I. General information

NPI: 1750585162
Provider Name (Legal Business Name): BLAIRE DAGOSTIN MCCURRY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 100TH ST SW STE B
LAKEWOOD WA
98499-2710
US

IV. Provider business mailing address

4848 N 8TH ST
TACOMA WA
98406-3012
US

V. Phone/Fax

Practice location:
  • Phone: 253-284-9800
  • Fax: 253-284-9801
Mailing address:
  • Phone: 205-396-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00010055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: