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General NPI Number Information
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NPI Number | 1700273695
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Entity Type | Individual
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Provider Name | STEPHEN BLANCH PTA
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Gender | Male
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Dates
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Enumeration Date | 04/19/2015
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Last Update Date | 04/19/2015
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Provider Practice Location Address
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Address Line | 125 BROAD ST
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City | WEYMOUTH
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State | MA
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Zip | 02188-2336
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Country | US
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Telephone | 781-377-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 11 FRONT ST APT 110
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City | WEYMOUTH
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State | MA
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Zip | 02188-1629
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Country | US
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Telephone | 518-376-9945
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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 | 8904
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License Number State | MA
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