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NPI Code Detail

MEDICARE: BENJAMIN J BLAIS PT

MEDICARE: BENJAMIN J BLAIS PT
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 Therapist025746NY

General Provider Information

NPI Number : 1780684993
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN J BLAIS PT
Provider Business Mailing Address
First Line : PO BOX 2002
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-4502
Country : US
Telephone Number : 315-449-2208
Fax Number : 315-362-5120
Provider Business Practice Location Address
First Line : 1603 COURT ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13208-1834
Country : US
Telephone Number : 315-445-7591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/08/2007

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Directions to “ BENJAMIN J BLAIS PT” Practice Location

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