Provider Demographics
NPI:1487913091
Name:BLIZZARD, ROBERT R III (DPT, PT, CSCS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:BLIZZARD
Suffix:III
Gender:M
Credentials:DPT, PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PALMER AVE
Mailing Address - Street 2:APT A
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5307
Mailing Address - Country:US
Mailing Address - Phone:203-517-9332
Mailing Address - Fax:
Practice Address - Street 1:43 PALMER AVE
Practice Address - Street 2:APT A
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5307
Practice Address - Country:US
Practice Address - Phone:203-517-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist