Michael T. Blair, PT, DPT, CMTPT
Individual provider Active NPI Physical Therapist · Richmond, VA
NPI 1154724979 · NPPES record last updated Nov 14, 2024
Key facts
- NPI
- 1154724979
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2305211263 (VA)
- Practice address
- 5901 W Broad St Ste 203
Richmond, VA 23230-2219 - Phone
- (804) 533-7577
- NPI assigned
- Oct 7, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ivyrehab Sept, LLC
Practice addresses (Care Compare)
5901 W Broad St
Suite 203
Richmond, VA 23230-2219
Phone (804) 533-7577
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180619001869 | VA | Practitioner - Physical Therapist in Private Practice | 0941527626 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab Sept, LLC | Physical Therapist | Current |
Accepting new patients |
| Ivyrehab Sept, LLC | Physical Medicine & Rehabilitation | Current |
Accepting new patients |
| Professional Sportscare & Rehab Associates, LLC | Physical Therapist | Past | Accepting new patients |
Locations
2275 Beech Ave
Buena Vista, VA 24416
Phone (540) 466-1000
5421 Patterson Ave
Richmond, VA 23226
Phone (804) 285-2006
5901 W Broad St
Ste 203
Richmond, VA 23230
Phone (804) 533-7577
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305211263 | VA | Yes |
Addresses
Primary practice location
5901 W Broad St Ste 203
Richmond, VA 23230-2219
Mailing address
PO Box 412307
Boston, MA 02241-2307
Phone (914) 294-4050
Other providers in Richmond, VA
- Mallory Elizabeth Blackwood
- Mark R Bladergroen
- Amanda R Blair
- Ann Wallace Blair
- Artavia Ann Blair
- Susan Blair
- Blairs Drug Store
- Blake Home Health Agency
- Blake Home Health Agency
- Blake Home Healthcare, LLC
All providers in Richmond, VA · Physical Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.