Provider Demographics
NPI:1346202769
Name:BLANCO FLOREZ, FABIOLA (PT)
Entity Type:Individual
Prefix:MRS
First Name:FABIOLA
Middle Name:
Last Name:BLANCO FLOREZ
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 1:6577 WILDERNESS TRL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4652
Mailing Address - Country:US
Mailing Address - Phone:317-596-8086
Mailing Address - Fax:
Practice Address - Street 1:2045 RAMA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1710
Practice Address - Country:US
Practice Address - Phone:317-635-3499
Practice Address - Fax:317-635-0449
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004564A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation