DR. NUTTA-ON BLAIR (NPI# 1508370453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508370453 |
| Entity Type | Individual |
| Full Name | DR. NUTTA-ON BLAIR |
| Other Name | NUTTA-ON PROMJUNYAKUL |
| Credential | PT, PHD |
| Practice Address |
6475 Jimmy Carter Blvd Ste 200 Norcross GA 30071-1734 |
| Mailing Address |
315 Rolling Mist Ct Alpharetta GA 30022-4405 |
| Practice Telephone | 7702427744 |
| Practice Fax Number | 7703680164 |
| Mailing Telephone | 4143241176 |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2251N0400X |
Physical Therapist Specialization: Neurology |
PTL.0014385 | CO | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 2251N0400X |
Physical Therapist Specialization: Neurology |
PT013222 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 2251P0200X |
Physical Therapist Specialization: Pediatrics |
PTL.0014385 | CO | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 2251P0200X |
Physical Therapist Specialization: Pediatrics |
PT013222 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
6475 JIMMY CARTER BLVD STE 200 |
| City | NORCROSS |
| State | GA |
| Zip Code | 30071-1734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295155679 | Melissa Tucker Khan | Physician Assistant | 6475 Jimmy Carter Blvd Ste 200, Norcross, GA 30071-1734 | 2014-04-23 |
| 1912414418 | Claire Camille Pavlich | Physical Therapist | 6475 Jimmy Carter Blvd Ste 200, Norcross, GA 30071-1734 | 2018-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477199867 | 1st Senior Cares, LLC | Home Health | 7116 Peachtree Industrial Blvd. Bldg. 4, Ste. B, Peachtree Corners, GA 30071 | 2019-11-21 |
| 1124660048 | Phil Scafidi | Massage Therapist | 50 Skin Alley, Norcross, GA 30071 | 2019-10-11 |
| 1063071454 | Kenanesha Owens | Counselor | 3040 Holcolmb Bridge Rd Suite J2, Norcross, GA 30071 | 2019-06-10 |
| 1407318389 | 1st Senior Homecare, LLC | Home Health | 7116 Peachtree Industrial Blvd., Bldg 4 Suite A, Peachtree Corners, GA 30071 | 2019-04-01 |
| 1982163689 | Jk Acupuncture LLC | Acupuncturist | 5390 Peachtree Industrial Bl #101, Norcross, GA 30071 | 2019-03-13 |
| 1063990778 | First Senior Center | Clinic/Center | 7116 Peachtree Industrial Blvd, Bldg 4, Peachtree Corners, GA 30071 | 2018-08-03 |
| 1952896904 | Sonal P Patel | Physical Therapy Assistant | 4709 Peachtree Ind Blvd, Suite 106, Norcross, GA 30071 | 2018-06-22 |
| 1700392354 | Medlink Ems Inc | Ambulance | 6825 Jimmy Carter Blvd Ste 1303, Norcross, GA 30071 | 2017-12-19 |
| 1205377975 | David Kalisz II | Specialist/Technologist, Other | 1880 Beaver Ridge Circle Suite D, Norcross, GA 30071 | 2017-03-15 |
| 1356792519 | Tiffany Pope | Counselor | 6045 Atlantic Blvd Ste 108, Norcross, GA 30071 | 2016-06-28 |
| Find all providers in zip 30071 | ||||
| Taxonomy Code | 2251N0400X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Neurology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942828595 | Classic City Rehab LLC | Physical Therapist | 184 Towns Walk Dr, Athens, GA 30606-7986 | 2020-07-10 |
| 1336772326 | Hafiza Fazal | Physical Therapist | 500 Lanier Ave W Ste 303, Fayetteville, GA 30214-7636 | 2020-02-18 |
| 1558738674 | Hannah Redd | Physical Therapist | 1792 Ridgeway Ave Nw, Atlanta, GA 30318-7512 | 2015-08-24 |
| 1235538877 | Lindsay White Walston | Physical Therapist | 1462 Clifton Rd Ne Ste 312, Atlanta, GA 30322-1000 | 2014-08-20 |
| 1245643626 | Sarah Caston | Physical Therapist | 3036 Clairmont Rd Ne, Apt D, Atlanta, GA 30329-1627 | 2014-06-03 |
| 1184820797 | Althea Tiggs Penn | Physical Therapist | 201 Lake Valley Dr, Loganville, GA 30052-7883 | 2007-06-21 |
| 1194846147 | Laura J Cohen | Physical Therapist | 134 Ridgeland Ave, Decatur, GA 30030-2054 | 2007-04-03 |
| 1013491091 | Christi N Acker | Physical Therapist | 12 Executive Park Dr Ne, Atlanta, GA 30329-2206 | 2018-09-17 |
| 1558845529 | Peyton Rose Kelly | Physical Therapist | 12 Executive Park Dr Ne, Atlanta, GA 30329-2206 | 2018-09-17 |
| 1003321704 | Jessica Ariel Smith | Physical Therapist | 597 S Enota Dr Ne, Gainesville, GA 30501-2545 | 2017-12-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.