Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 28774 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT 28774 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT 28774 | FL |
NPI | 1407278815 |
---|---|
Provider Name | Cristina Blanco |
First Address | Miami, FL 33176-2231 |
Second Address | Miami, FL 33176-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2014 |
Last Update Date | 21/01/2014 |