Provider Demographics
NPI:1699854372
Name:BLAIR, JESSICA RAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:101 MANOR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-349-7799
Mailing Address - Fax:502-349-1484
Practice Address - Street 1:101 MANOR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-349-7799
Practice Address - Fax:502-349-1484
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist