Provider Demographics
NPI:1275716128
Name:BLANCO, YVONNE CECILIA (PT)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:CECILIA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:YVONNE
Other - Middle Name:CECILIA
Other - Last Name:SAYAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7780 MARSH CT NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1800
Mailing Address - Country:US
Mailing Address - Phone:404-252-2274
Mailing Address - Fax:404-252-2274
Practice Address - Street 1:1165 PEPSI PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2866
Practice Address - Country:US
Practice Address - Phone:434-951-4200
Practice Address - Fax:434-951-4202
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007929225100000X
VA2305003624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist