Provider Demographics
NPI:1235963562
Name:BLAIR, ANTHONY M (OTR/L)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:BLAIR
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 N LOS FELICES RD UNIT 108
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-0641
Mailing Address - Country:US
Mailing Address - Phone:973-803-9158
Mailing Address - Fax:
Practice Address - Street 1:2875 N LOS FELICES RD UNIT 108
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0641
Practice Address - Country:US
Practice Address - Phone:973-803-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26824208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation