Provider Demographics
NPI:1982662870
Name:BLONDHEIM, IRA LANE (PT)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:LANE
Last Name:BLONDHEIM
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 1:800 CRESCENT CENTRE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7286
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:6971 EASTCHASE LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6876
Practice Address - Country:US
Practice Address - Phone:334-721-6500
Practice Address - Fax:334-721-6501
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-20068OtherBCBS NUMBER
AL051520068Medicare ID - Type UnspecifiedMEDICARE