Individual
MR. BRENT A BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
200 GREYSTONE DR, BEAVER, WV 25813-9154
(304) 860-1952
Mailing address
200 GREYSTONE DR, BEAVER, WV 25813-9154
(304) 860-1952
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 001737
WV
Other
Enumeration date
09/28/2012
Last updated
09/28/2012
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