Krissaley Vonn Blair, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT34661 Issued in FL

Practice address

4343 Newberry Rd Ste 4
Gainesville, FL 32607-2822

Phone

(352) 373-6565

Fax

(352) 224-1974

NPI assigned

Sep 6, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physical Therapy Professionals LLCGroup PAC ID 2567461825, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physical Therapy Professionals, LLC

  • Physical Therapist
  • Melbourne, FL
  • NPI 1639276900
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567728000000",
    "number": "1508415035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 357279",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326357279",
            "telephone_number": "352-373-6565",
            "fax_number": "352-224-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 NEWBERRY RD STE 4",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326072822",
            "telephone_number": "352-373-6565",
            "fax_number": "352-224-1974"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3919 Newberry Rd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326074828",
            "country_code": "US",
            "telephone_number": "352-373-7984",
            "fax_number": "352-224-1974",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "KRISSALEY",
        "middle_name": "VONN",
        "name_prefix": "Dr.",
        "credential": "PT,  DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-06",
        "last_updated": "2019-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT34661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cecil Blackmon
• Timmary Blackstock
• Claire Blain
• Ally Blair
• Brenda Blair
• William Olin Blair III, MD
• Yooni Blair, MD
• Jennifer Carly Blaire
• Charles Richard Blake, MD
• Erica Kukulka Blake, MS, RD, LD/N

• Physical Therapist in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.