Provider Demographics
NPI:1467985903
Name:DOLAN, BLAIR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:ELISABETH
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 FOSS RD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4512
Mailing Address - Country:US
Mailing Address - Phone:612-788-9673
Mailing Address - Fax:
Practice Address - Street 1:3700 FOSS RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4512
Practice Address - Country:US
Practice Address - Phone:612-788-9673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251G0304X
MN2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics