Individual
MR. BLAIR ANTHONY TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2709 BLUE RIDGE RD, SUITE 200, RALEIGH, NC 27607-6462
(919) 784-4696
Mailing address
105 TATTENHALL DR, CARY, NC 27511-2406
(919) 303-8399
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10009
NC
225100000X
Physical Therapist
PT003109
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079UU
BLUECROSS BLUESHIELD NC
NC
Enumeration date
03/16/2006
Last updated
07/08/2007
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