Individual
MR. BLAIR ANTHONY TANNER
Active
Individual
MR. BLAIR ANTHONY TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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
Update your record
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