Provider Demographics
NPI:1164536462
Name:BLANCHARD, JOANNE R (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:R
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PLAZA DR.
Mailing Address - Street 2:UNIT 6
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-289-1010
Mailing Address - Fax:207-289-1011
Practice Address - Street 1:25 PLAZA DR.
Practice Address - Street 2:UNIT 6
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-289-1010
Practice Address - Fax:207-289-1011
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11223452OtherCAQH #
MEME 1071Medicare ID - Type UnspecifiedPROVIDER ID