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Individual
LISA BLAS
Active
Individual
LISA BLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
017317
NY
225100000X
Physical Therapist
PT017089
GA
225100000X
Physical Therapist
Primary
PT41361
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025703502
UNIVERA
—
01
—
000625539003
BLUE CROSS
—
01
—
9390538
IHA
NY
Enumeration date
08/30/2006
Last updated
10/31/2024
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