Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 10754 | AZ |
NPI | 1275957540 |
---|---|
Provider Name | Dr. Michael Ray Blankenship |
First Address | Tempe, AZ 85284-2800 |
Second Address | Tempe, AZ 85284-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2014 |
Last Update Date | 07/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T64322062 | PHYSICAL THERAPY, ATHLETIC TRAINER (01) | AZ |