MEDICARE: DR. BLANCA DELATORRE DPT

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	225100000X	Physical Therapist	11-07734	KS

General Provider Information

NPI Number	:	1578390589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLANCA DELATORRE DPT

Provider Business Mailing Address
First Line	:	PO BOX 797
Second Line	:
City	:	HOOKER
State	:	OK
Zip	:	73945-0797
Country	:	US
Telephone Number	:	620-624-2980
Fax Number	:	620-624-2985

Provider Business Practice Location Address
First Line	:	1452 N WESTERN AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2212
Country	:	US
Telephone Number	:	620-624-2980
Fax Number	:	620-624-2985

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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