MEDICARE: MICHAEL DAVID BLAIR PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	14357	TN

General Provider Information

NPI Number	:	1518687052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID BLAIR PT, DPT

Provider Business Mailing Address
First Line	:	564 OAK RIDGE TURNPIKE
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-7164
Country	:	US
Telephone Number	:	865-213-2744
Fax Number	:	865-315-7033

Provider Business Practice Location Address
First Line	:	111 FOX RD STE 101
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-9000
Country	:	US
Telephone Number	:	865-351-0615
Fax Number	:	865-622-9566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	12/01/2025

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