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General NPI Number Information
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NPI Number | 1457028490
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Entity Type | Individual
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Provider Name | ADAM BLAINE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 225 REINEKERS LN
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2856
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Country | US
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Telephone | 703-672-7208
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 4TH ST N APT 108
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City | ARLINGTON
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State | VA
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Zip | 22203-3006
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Country | US
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Telephone | 304-923-2694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305214641
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License Number State | VA
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