Provider Demographics
NPI:1306808639
Name:BLAIR, CAROL D (PT, OCS, SCS, CSCS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PT, OCS, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:14075R SOUTH FIRST ST.
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-0712
Mailing Address - Country:US
Mailing Address - Phone:731-686-2010
Mailing Address - Fax:731-686-3798
Practice Address - Street 1:14075R S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-6195
Practice Address - Country:US
Practice Address - Phone:731-686-2010
Practice Address - Fax:731-686-3798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38756OtherBCBS PROVIDER #
TN38756OtherBCBS PROVIDER #