Provider Demographics
NPI:1356820989
Name:BLATCHFORD, JUSTIN L (PT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:L
Last Name:BLATCHFORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10118 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5555
Mailing Address - Country:US
Mailing Address - Phone:402-939-7939
Mailing Address - Fax:402-939-7940
Practice Address - Street 1:10118 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5555
Practice Address - Country:US
Practice Address - Phone:402-939-7939
Practice Address - Fax:402-939-7940
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE38812251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic