Individual
BEAU BLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-9990
(215) 243-3297
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-9990
(215) 243-3297
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/16/2025
Last updated
04/16/2025
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