Provider Demographics
NPI:1235495045
Name:OBLANCA, RAY JOHN
Entity Type:Individual
Prefix:
First Name:RAY JOHN
Middle Name:
Last Name:OBLANCA
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 1:2150 HOLLOW BROOK DR.
Mailing Address - Street 2:STE. 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8414
Mailing Address - Country:US
Mailing Address - Phone:214-218-4031
Mailing Address - Fax:
Practice Address - Street 1:2150 HOLLOW BROOK DR.
Practice Address - Street 2:STE. 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8414
Practice Address - Country:US
Practice Address - Phone:214-218-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT-10253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist