Provider Demographics
NPI:1508415035
Name:BLAIR, KRISSALEY VONN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISSALEY
Middle Name:VONN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357279
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7279
Mailing Address - Country:US
Mailing Address - Phone:352-373-6565
Mailing Address - Fax:352-224-1974
Practice Address - Street 1:4343 NEWBERRY RD STE 4
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2822
Practice Address - Country:US
Practice Address - Phone:352-373-6565
Practice Address - Fax:352-224-1974
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist