Provider Demographics
NPI:1205898061
Name:BLEND, MARY BETH (MS, PT, OCS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:BLEND
Suffix:
Gender:F
Credentials:MS, PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WILLOW LAWN DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3003
Mailing Address - Country:US
Mailing Address - Phone:804-340-1193
Mailing Address - Fax:804-340-1930
Practice Address - Street 1:1700 WILLOW LAWN DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3003
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:804-340-1930
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192935OtherBCBS PHYSICAL THERAPY
VA010140412Medicaid
VAP00271177OtherRAILROAD MEDICARE
7026532OtherAETNA
VAP00271177OtherRAILROAD MEDICARE
VAC05954Medicare PIN