Healthcare Provider Details

I. General information

NPI: 1255780524
Provider Name (Legal Business Name): BLAIR INVESTMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 PRAIRIE AVE
CHEYENNE WY
82009-4867
US

IV. Provider business mailing address

1541 CENTENNIAL CT
CASPER WY
82609-7304
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-4617
  • Fax:
Mailing address:
  • Phone: 307-235-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1629
License Number StateWY

VIII. Authorized Official

Name: KATHY BLAIR
Title or Position: OWNER
Credential: DPT
Phone: 307-235-3910