Provider Demographics
NPI:1205895711
Name:BLASER PHYSICAL THERAPY
Entity type:Organization
Organization Name:BLASER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-341-1922
Mailing Address - Street 1:40 NORTH HILL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2610
Mailing Address - Country:US
Mailing Address - Phone:540-341-1922
Mailing Address - Fax:540-341-1923
Practice Address - Street 1:40 NORTH HILL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2610
Practice Address - Country:US
Practice Address - Phone:540-341-1922
Practice Address - Fax:540-341-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194042OtherBLUE CROSS BLUE SHIELD
VA194042OtherBLUE CROSS BLUE SHIELD