Active NPI
Blair Braz
- Orthopedic Physical Therapist
- Chula Vista, CA
National Provider Identifier
1134906068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 302615
- Practice address
- 865 Third Ave
Chula Vista, CA 91911-1300 - Phone
- (619) 500-8044
- NPI assigned
- Sep 13, 2023
- Last updated
- Sep 13, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 302615 | CA | Primary |
Addresses
Primary practice location
865 Third Ave
Chula Vista, CA 91911-1300
Mailing address
2755 Teresita St
San Diego, CA 92104-5254
Phone (858) 335-5203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240503001787 | CA | Practitioner - Physical Therapist in Private Practice | 5698115905 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302615 | CA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1134906068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2755 TERESITA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921045254",
"telephone_number": "858-335-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "865 THIRD AVE",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919111300",
"telephone_number": "619-500-8044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZ",
"first_name": "BLAIR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-13",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "CA",
"license": "302615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.