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General NPI Number Information
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NPI Number | 1508202128
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Entity Type | Individual
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Provider Name | MRS. JESSICA BLANDO
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Gender | Female
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 174 PRESTON RD APT D 3
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City | MILFORD
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State | NJ
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Zip | 08848
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Country | US
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Telephone | 908-405-1465
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Fax |
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Provider Business Mailing Address
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Address Line | 174 PRESTON RD APT D3
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City | MILFORD
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State | NJ
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Zip | 08848-1248
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Country | US
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Telephone | 908-405-1465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00253000
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License Number State | NJ
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