Provider Demographics
NPI:1033650890
Name:BLANTON, JOESPH
Entity Type:Individual
Prefix:
First Name:JOESPH
Middle Name:
Last Name:BLANTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 SW 200TH ST UNIT 304
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8426
Mailing Address - Country:US
Mailing Address - Phone:984-203-1409
Mailing Address - Fax:
Practice Address - Street 1:11000 SW 200TH ST UNIT 304
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8426
Practice Address - Country:US
Practice Address - Phone:984-203-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician