Provider Demographics
NPI:1942194964
Name:BLASER-VANDERHAVE, LYNN M (PTA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:BLASER-VANDERHAVE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:BLASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3922 E WHITE ASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6656
Mailing Address - Country:US
Mailing Address - Phone:602-363-8683
Mailing Address - Fax:
Practice Address - Street 1:3922 E WHITE ASTER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6656
Practice Address - Country:US
Practice Address - Phone:602-363-8683
Practice Address - Fax:602-363-8683
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant