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General NPI Number Information
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NPI Number | 1962103101
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Entity Type | Organization
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Legal Business Name | CARMEN E BLATNICK
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 1005 S COUNTRY CLUB RD
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City | STILLWATER
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State | OK
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Zip | 74074-1430
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Country | US
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Telephone | 517-575-5493
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 S COUNTRY CLUB RD
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City | STILLWATER
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State | OK
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Zip | 74074-1430
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Country | US
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Telephone | 517-575-5493
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMEN E BLATNICK
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Credential |
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Telephone | 517-575-5493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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