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General NPI Number Information
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NPI Number | 1639930191
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Entity Type | Individual
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Provider Name | BLAIN ALAN PACKARD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 120 W HIGHWAY 287 STE 2
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City | FLORENCE
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State | AZ
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Zip | 85132-8170
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Country | US
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Telephone | 480-684-4728
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Fax |
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Provider Business Mailing Address
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Address Line | 23296 N HIGH DUNES DR
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City | FLORENCE
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State | AZ
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Zip | 85132-7925
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Country | US
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Telephone | 480-684-4728
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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 | 10016A
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License Number State | AZ
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