MEDICARE: MR. DANIEL P BLECHA PTA

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	225200000X	Physical Therapy Assistant	1145-019	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093923153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL P BLECHA PTA

Provider Business Mailing Address
First Line	:	5049 W COLLEGE AVE APT 63
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2952
Country	:	US
Telephone Number	:	414-687-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 S CHICAGO AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3708
Country	:	US
Telephone Number	:	414-764-4100
Fax Number	:

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/09/2007

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