Provider Demographics
NPI:1811256357
Name:BLAIR, RASHEDA (LMT)
Entity type:Individual
Prefix:MS
First Name:RASHEDA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E HORTTER ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3603
Mailing Address - Country:US
Mailing Address - Phone:215-301-0683
Mailing Address - Fax:
Practice Address - Street 1:905 E HORTTER ST
Practice Address - Street 2:1ST FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3603
Practice Address - Country:US
Practice Address - Phone:215-301-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist