Provider Demographics
NPI:1477861748
Name:BLAU, LIDA MARIE (CPTA)
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:MARIE
Last Name:BLAU
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3791
Mailing Address - Country:US
Mailing Address - Phone:785-825-1366
Mailing Address - Fax:785-493-8121
Practice Address - Street 1:2601 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3791
Practice Address - Country:US
Practice Address - Phone:785-825-1366
Practice Address - Fax:785-493-8121
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00927225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant