Provider Demographics
NPI:1427731975
Name:BLAS, CHRISTINE K (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:K
Last Name:BLAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:CAYANAN
Other - Last Name:KOBASHIKAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 LILLY RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5430
Mailing Address - Country:US
Mailing Address - Phone:360-486-0604
Mailing Address - Fax:
Practice Address - Street 1:360 LILLY RD NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5430
Practice Address - Country:US
Practice Address - Phone:360-486-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61423609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty