MEDICARE: BLANKINSHIP PHYSICAL THERAPY PC

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	4181	AZ

General Provider Information

NPI Number	:	1770672909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLANKINSHIP PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	1534 E RAY RD STE 104
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4429
Country	:	US
Telephone Number	:	480-855-5542
Fax Number	:	480-855-5756

Provider Business Practice Location Address
First Line	:	1534 E RAY RD STE 104
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4429
Country	:	US
Telephone Number	:	480-855-5542
Fax Number	:	480-855-5756

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CRAIG A BLANKINSHIP
Credential	:	MSPT
Telephone Number	:	480-855-5542

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/22/2011

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