Provider Demographics
NPI:1275957540
Name:BLANKENSHIP, MICHAEL RAY (PT, DPT, MS, ATC/LAT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PT, DPT, MS, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 S HARDY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2800
Mailing Address - Country:US
Mailing Address - Phone:160-237-9171
Mailing Address - Fax:
Practice Address - Street 1:8701 S HARDY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2800
Practice Address - Country:US
Practice Address - Phone:160-237-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ107542251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT64322062OtherPHYSICAL THERAPY, ATHLETIC TRAINER
VAT64322062Medicare PIN