Provider Demographics
NPI:1235224320
Name:BLOSSER, CHRISTYN RAE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTYN
Middle Name:RAE
Last Name:BLOSSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 BAY RD
Mailing Address - Street 2:SUITE 1 S
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2417
Mailing Address - Country:US
Mailing Address - Phone:989-793-0773
Mailing Address - Fax:989-793-0272
Practice Address - Street 1:3875 BAY RD
Practice Address - Street 2:SUITE 1 S
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2417
Practice Address - Country:US
Practice Address - Phone:989-793-0773
Practice Address - Fax:989-793-0272
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30647OtherBCBS
MI236573Medicare ID - Type UnspecifiedMEDICARE