Provider Demographics
NPI:1437249232
Name:BLOT, PHILIPPE MARIE (PT)
Entity Type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:MARIE
Last Name:BLOT
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 1:16306 MIDNIGHT XING
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1654
Mailing Address - Country:US
Mailing Address - Phone:631-241-4221
Mailing Address - Fax:
Practice Address - Street 1:16306 MIDNIGHT XING
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1654
Practice Address - Country:US
Practice Address - Phone:631-241-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020557225100000X
VA2305211457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist