Provider Demographics
NPI:1952561532
Name:BLAIR, KRISTY A (DPT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:A
Other - Last Name:LAING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16004 NORMANDY CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4321
Mailing Address - Country:US
Mailing Address - Phone:860-608-5019
Mailing Address - Fax:
Practice Address - Street 1:16004 NORMANDY CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4321
Practice Address - Country:US
Practice Address - Phone:860-608-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32648174400000X
VA2305207764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist