Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT5687 | OH |
N | 2251S0007X | Physical Therapist - Sports | PT5687 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT5687 | OH |
NPI | 1265423321 |
---|---|
Provider Name | Joseph Blasiole |
First Address | Ravenna, OH 44266-3218 |
Second Address | Ravenna, OH 44266-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AT001574 | OHIO OT, PT, ATC BOARD (01) | OH |
PT05687 | OHIO OT, PT, ATC BOARD (01) | OH |