Provider Demographics
NPI:1942833082
Name:BLANDON, KLAUS
Entity Type:Individual
Prefix:
First Name:KLAUS
Middle Name:
Last Name:BLANDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14947 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2056
Mailing Address - Country:US
Mailing Address - Phone:305-616-2789
Mailing Address - Fax:
Practice Address - Street 1:2900 DELK RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5320
Practice Address - Country:US
Practice Address - Phone:470-632-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist