MEDICARE: CAROLYN MICHELLE BLANCO

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

General Provider Information

NPI Number	:	1659264521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN MICHELLE BLANCO

Provider Business Mailing Address
First Line	:	8808 WYNDBROOK CT
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-1713
Country	:	US
Telephone Number	:	813-598-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	6417 E COUNTY LINE RD STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1855
Country	:	US
Telephone Number	:	813-461-8840
Fax Number	:	813-461-8834

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

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	06/01/2025

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Directions to “ CAROLYN MICHELLE BLANCO ” Practice Location

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