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General NPI Number Information
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NPI Number | 1801132808
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Entity Type | Individual
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Provider Name | JOHN L BLOUNT PTA
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Gender | Male
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 210 E HIGHLAND DR RGH PT @ MIDTOWN HEALTH CLUB
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City | ROCHESTER
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State | NY
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Zip | 14610-3008
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Country | US
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Telephone | 585-244-9580
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Fax | 585-922-2396
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Provider Business Mailing Address
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Address Line | 210 EAST HIGHLAND DRIVE RGH PT @ MIDTOWN HEALTH CLUB
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City | ROCHESTER
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State | NY
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Zip | 14610-3008
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Country | US
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Telephone | 585-244-9580
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Fax | 585-922-2396
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 004022
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License Number State | NY
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