MEDICARE: CRAIG A BLANKINSHIP MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4181	AZ

General Provider Information

NPI Number	:	1093851693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG A BLANKINSHIP MSPT

Provider Business Mailing Address
First Line	:	734 E ELGIN ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-6580
Country	:	US
Telephone Number	:	480-855-5542
Fax Number	:	480-855-5756

Provider Business Practice Location Address
First Line	:	1534 E RAY RD
Second Line	:	SUITE 104
City	:	GILBERT
State	:	AZ
Zip	:	85296-4429
Country	:	US
Telephone Number	:	480-855-5542
Fax Number	:	480-855-5756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	12/22/2011

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Practice Location Address:

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