MEDICARE: KIMBERLY VEEDER BLANCHARD MPT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5692	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134157886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY VEEDER BLANCHARD MPT, ATC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	6261 N LA CHOLLA BLVD
Second Line	:	SUITE 211
City	:	TUCSON
State	:	AZ
Zip	:	85741-3565
Country	:	US
Telephone Number	:	520-822-8640
Fax Number	:	520-822-8641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	04/22/2016

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Directions to “ KIMBERLY VEEDER BLANCHARD MPT, ATC” Practice Location

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