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NPI Code Detail

MEDICARE: JONATHAN BLOSSER PT, DPT

MEDICARE: JONATHAN BLOSSER 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1629661608
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BLOSSER PT, DPT
Provider Business Mailing Address
First Line : 3408 HANOVER AVE APT A
Second Line :
City : RICHMOND
State : VA
Zip : 23221-2736
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 WILKES RIDGE DR
Second Line :
City : RICHMOND
State : VA
Zip : 23233-7632
Country : US
Telephone Number : 804-877-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2021
Last Update Date : 02/19/2021

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