Healthcare Provider Details

I. General information

NPI: 1427824382
Provider Name (Legal Business Name): BLANCO PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAIN ST
BLANCO TX
78606-4900
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 830-833-3068
  • Fax:
Mailing address:
  • Phone: 414-858-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG FRANK NEFFENDORF
Title or Position: OWNER
Credential: PT
Phone: 830-833-3068