Provider Demographics
NPI:1316554538
Name:BLANCHARD, EVELYN DIANNE (PT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DIANNE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:E
Other - Middle Name:DIANNE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:849 W GORE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2550
Mailing Address - Country:US
Mailing Address - Phone:814-864-8430
Mailing Address - Fax:
Practice Address - Street 1:2628 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1421
Practice Address - Country:US
Practice Address - Phone:814-838-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008010L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty