Provider Demographics
NPI:1306675442
Name:SABLATURA, BLAINE ANTHONY (PTA)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:ANTHONY
Last Name:SABLATURA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9402 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-8551
Mailing Address - Country:US
Mailing Address - Phone:979-665-1230
Mailing Address - Fax:
Practice Address - Street 1:2630 N MASON RD STE A1
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3057
Practice Address - Country:US
Practice Address - Phone:346-460-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2183629225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant