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NPI Code Detail

MEDICARE: MATTHEW BLAIR PTA

MEDICARE: MATTHEW BLAIR PTA
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
1225200000XPhysical Therapy Assistant06006588AIN
2225200000XPhysical Therapy Assistant2561-19WI
3225200000XPhysical Therapy Assistant10061MA
4225200000XPhysical Therapy Assistant2349CT
5225200000XPhysical Therapy AssistantPT-2023-2389NM

General Provider Information

NPI Number : 1699226506
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW BLAIR PTA
Provider Business Mailing Address
First Line : PO BOX 427
Second Line :
City : NORA
State : IL
Zip : 61059-0427
Country : US
Telephone Number : 608-228-1721
Fax Number :
Provider Business Practice Location Address
First Line : 3514 N FOWLER AVE
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-7210
Country : US
Telephone Number : 575-388-3127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2016
Last Update Date : 12/20/2023

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