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NPI Code Detail

MEDICARE: MRS. JULIE A BLANK PT

MEDICARE: MRS. JULIE A BLANK PT
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
1225100000XPhysical TherapistPT19653FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00052941OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y0469OTHERFLBLUE CROSS & BLUE SHIELD
2PT19653OTHERFLPT LICENSE

General Provider Information

NPI Number : 1518925353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE A BLANK PT
Provider Business Mailing Address
First Line : 5968 CLARK CENTER AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34238-2715
Country : US
Telephone Number : 941-922-8200
Fax Number : 941-343-9402
Provider Business Practice Location Address
First Line : 5968 CLARK CENTER AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34238-2715
Country : US
Telephone Number : 941-922-8200
Fax Number : 941-343-9402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 02/03/2016

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Directions to “ MRS. JULIE A BLANK PT” Practice Location

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