Healthcare Provider Details

I. General information

NPI: 1649323460
Provider Name (Legal Business Name): KATHY J BLAIR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 CENTENNIAL CT
CASPER WY
82609-7304
US

IV. Provider business mailing address

1541 CENTENNIAL CT
CASPER WY
82609-7304
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-3910
  • Fax:
Mailing address:
  • Phone: 307-235-3910
  • Fax: 307-266-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number20425
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15216
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number496
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: