Healthcare Provider Details

I. General information

NPI: 1891042883
Provider Name (Legal Business Name): JOSHUA ALAN BLANCHARD PT, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S STATE ROAD 135 STE 110
GREENWOOD IN
46143-9607
US

IV. Provider business mailing address

1317 DE SOTO COURT
INDIANAPOLIS IN
46217
US

V. Phone/Fax

Practice location:
  • Phone: 317-535-4075
  • Fax: 317-535-4076
Mailing address:
  • Phone: 317-865-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: