Provider Demographics
NPI:1396765343
Name:BLATT, JOSEPH EDWARD
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:BLATT
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 1:25612 E 31ST TER S
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-1152
Mailing Address - Country:US
Mailing Address - Phone:816-224-6982
Mailing Address - Fax:816-229-6478
Practice Address - Street 1:801 NW ST MARY'S DRIVE
Practice Address - Street 2:STE. 102
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-229-6622
Practice Address - Fax:816-229-6478
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist