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General NPI Number Information
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NPI Number | 1902916216
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Entity Type | Individual
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Provider Name | LISA BLAS PT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 450077 STATE ROAD 200
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City | CALLAHAN
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State | FL
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Zip | 32011-3863
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Country | US
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Telephone | 904-980-0119
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Fax | 904-879-9541
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Provider Business Mailing Address
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Address Line | 450077 STATE ROAD 200
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City | CALLAHAN
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State | FL
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Zip | 32011-3863
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Country | US
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Telephone | 904-980-0119
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Fax | 904-879-9541
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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 | 017317
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License Number State | NY
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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 | PT017089
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License Number State | GA
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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 | PT41361
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License Number State | FL
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