Provider Demographics
NPI:1013027549
Name:BLAIR, ANNA-KATHERINE (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:ANNA-KATHERINE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:ANNA-KATHERINE
Other - Middle Name:
Other - Last Name:SEVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT,CSCS
Mailing Address - Street 1:10859 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2405
Mailing Address - Country:US
Mailing Address - Phone:314-521-3000
Mailing Address - Fax:314-521-7800
Practice Address - Street 1:10859 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63136-2405
Practice Address - Country:US
Practice Address - Phone:314-521-3000
Practice Address - Fax:314-521-7800
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020058582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001758Medicare PIN