Provider Demographics
NPI:1154964237
Name:BLASI, KENDALL (DPT)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:BLASI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 BALMORAL DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5633
Mailing Address - Country:US
Mailing Address - Phone:256-883-1970
Mailing Address - Fax:256-883-8061
Practice Address - Street 1:4240 BALMORAL DR SW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5633
Practice Address - Country:US
Practice Address - Phone:256-883-1970
Practice Address - Fax:256-883-8061
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist