Blair Elise Nettles, DPT, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305211755 Issued in VA

Practice address

17909 N Shore Dr
Purcellville, VA 20132-3980

Phone

(540) 931-3037

Fax

(571) 363-2753

NPI assigned

Mar 22, 2018

Last updated

Mar 22, 2018By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521676800000",
    "number": "1750885844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17909 N SHORE DR",
            "city": "PURCELLVILLE",
            "state": "VA",
            "postal_code": "201323980",
            "telephone_number": "540-931-3037",
            "fax_number": "571-363-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17909 N SHORE DR",
            "city": "PURCELLVILLE",
            "state": "VA",
            "postal_code": "201323980",
            "telephone_number": "540-931-3037",
            "fax_number": "571-363-2753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "BLAIR",
        "middle_name": "ELISE",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-22",
        "last_updated": "2018-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Purcellville, VA
• Providers in Purcellville, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.