Provider Demographics
NPI:1093851693
Name:BLANKINSHIP, CRAIG A (MSPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:BLANKINSHIP
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6580
Mailing Address - Country:US
Mailing Address - Phone:480-855-5542
Mailing Address - Fax:480-855-5756
Practice Address - Street 1:1534 E RAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4429
Practice Address - Country:US
Practice Address - Phone:480-855-5542
Practice Address - Fax:480-855-5756
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist