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Individual
MR. SHERMAN B BLYSTONE JR.
Active
Individual
MR. SHERMAN B BLYSTONE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1009
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0779V
BCBS
NC
01
—
271572B
MEDICARE PART B GROUP
NC
05
—
720779V
—
NC
Enumeration date
01/02/2007
Last updated
06/24/2008
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