Provider Demographics
NPI:1083381586
Name:BLAIR, BRANDON (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BLAIR
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 1:375 E ELLIOT RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1122
Mailing Address - Country:US
Mailing Address - Phone:480-912-6400
Mailing Address - Fax:480-350-7081
Practice Address - Street 1:375 E ELLIOT RD STE 7
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1122
Practice Address - Country:US
Practice Address - Phone:480-912-6400
Practice Address - Fax:480-350-7081
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist