Provider Demographics
NPI:1457681256
Name:BLAIR, CHRISTOPHER COLE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:COLE
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 LAKE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-6524
Mailing Address - Country:US
Mailing Address - Phone:850-376-3269
Mailing Address - Fax:
Practice Address - Street 1:57 UPTOWN GRAYTON CIR STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8814
Practice Address - Country:US
Practice Address - Phone:850-231-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 7972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist