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General NPI Number Information
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NPI Number | 1528235785
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Entity Type | Individual
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Provider Name | TRACEY JEAN BLAIN PRC, MSPT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 1501 N BICKETT BLVD STE F
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City | LOUISBURG
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State | NC
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Zip | 27549-2178
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Country | US
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Telephone | 919-497-8414
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 N BICKETT BLVD STE F
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City | LOUISBURG
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State | NC
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Zip | 27549-2178
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Country | US
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Telephone |
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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 | PHY1129
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT36982
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011512
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P24556
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License Number State | NC
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