MEDICARE: PIERRE BLASIAK

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	PT42642	FL

General Provider Information

NPI Number	:	1861202764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERRE BLASIAK

Provider Business Mailing Address
First Line	:	665 NE 195TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3339
Country	:	US
Telephone Number	:	786-890-9870
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 NE 195TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3339
Country	:	US
Telephone Number	:	786-890-9870
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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Directions to “ PIERRE BLASIAK ” Practice Location

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