Individual
CONNOR ALEXANDER BLANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1043 JACK VEST DRIVE, JOHNSON CITY, TN 37614
(423) 439-5264
Mailing address
1185 W MOUNTAIN VIEW RD APT 2104, JOHNSON CITY, TN 37604-2536
(704) 473-6507
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14375
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q086335
—
TN
Enumeration date
08/24/2023
Last updated
01/16/2024
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