Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 1227055 | TX |
N | 213ES0000X | Sports Medicine | 1227055 | TX |
Y | 225100000X | Physical Therapist | 11479 | AZ |
NPI | 1083045827 |
---|---|
Provider Name | Blair Gregory Bundy |
First Address | Scottsdale, AZ 85258-4586 |
Second Address | Scottsdale, AZ 85258-4586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 17/04/2015 |