Provider Demographics
NPI:1003847328
Name:BLAIR, PATRICK S (PT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:BLAIR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:7225 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1101
Practice Address - Country:US
Practice Address - Phone:708-361-5355
Practice Address - Fax:708-361-5399
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0003622255A2300X
IL9711003002251H1200X
IL070006441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
ILCJ4383OtherRAILROAD MEDICARE GRP
IL367885100OtherUS DEPT OF LABOR
IL1623066OtherBCBS PROVIDER NUMBER
IL650022358OtherRAILROAD MEDICARE PIN
ILL86843Medicare PIN
IL568150Medicare PIN
IL1623066OtherBCBS PROVIDER NUMBER
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP
ILR02412Medicare PIN
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILR02411Medicare PIN
IL367885100OtherUS DEPT OF LABOR
ILR02413Medicare PIN