Individual
JONATHAN BLAISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 N BOONE ST, JOHNSON CITY, TN 37604
(423) 929-2900
Mailing address
3004 SHELBY ST, BRISTOL, TN 37620-3478
(518) 569-9887
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8222
TN
Other
Enumeration date
08/12/2022
Last updated
08/12/2022
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