Provider Demographics
NPI:1578561353
Name:BLAIS, GREG (PT)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:BLAIS
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 1:90 SOUTHSIDE AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4160
Mailing Address - Country:US
Mailing Address - Phone:828-254-3525
Mailing Address - Fax:828-254-0792
Practice Address - Street 1:90 SOUTHSIDE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4160
Practice Address - Country:US
Practice Address - Phone:828-254-3525
Practice Address - Fax:828-254-0792
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0780BOtherBCBS
NC2502344Medicare ID - Type Unspecified