Provider Demographics
NPI:1699142810
Name:BLARE, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BLARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2932
Mailing Address - Country:US
Mailing Address - Phone:325-437-3687
Mailing Address - Fax:325-437-1827
Practice Address - Street 1:4351 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8746
Practice Address - Country:US
Practice Address - Phone:325-665-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist