Provider Demographics
NPI:1144608134
Name:BLAIR, ALICIA (DPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:SYMINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT
Mailing Address - Street 1:7581 9TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6635
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:
Practice Address - Street 1:121 7TH AVE W
Practice Address - Street 2:
Practice Address - City:FLOODWOOD
Practice Address - State:MN
Practice Address - Zip Code:55736-1200
Practice Address - Country:US
Practice Address - Phone:218-481-7603
Practice Address - Fax:218-481-7601
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MN11805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer