Provider Demographics
NPI:1710148374
Name:BLAIR, LAUREN C (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:C
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GRANITE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5350
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:360 BROCKTON AVE
Practice Address - Street 2:STE 205
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2186
Practice Address - Country:US
Practice Address - Phone:781-878-5550
Practice Address - Fax:781-878-5472
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62P64553225100000X
IN05010449A225100000X
MA20478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110113552AMedicaid
MAS400305304OtherMEDICARE PTAN