Provider Demographics
NPI:1083045827
Name:BUNDY, BLAIR GREGORY (DPT)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:GREGORY
Last Name:BUNDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9917 N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4586
Mailing Address - Country:US
Mailing Address - Phone:480-314-1533
Mailing Address - Fax:480-314-5795
Practice Address - Street 1:9917 N 95TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4586
Practice Address - Country:US
Practice Address - Phone:480-314-1533
Practice Address - Fax:480-314-5795
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12270552081S0010X
AZ11479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine