MEDICARE: CODY BLANCHARD ATP

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1487295424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY BLANCHARD ATP

Provider Business Mailing Address
First Line	:	491B THIS WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5144
Country	:	US
Telephone Number	:	832-914-0991
Fax Number	:

Provider Business Practice Location Address
First Line	:	491B THIS WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5144
Country	:	US
Telephone Number	:	832-914-0991
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	08/08/2025

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Directions to “ CODY BLANCHARD ATP” Practice Location

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