Provider Demographics
NPI:1417363946
Name:BLOHOWIAK, MAXINE AMA (ATC)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:AMA
Last Name:BLOHOWIAK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 MOLLY BROWN LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7300
Mailing Address - Country:US
Mailing Address - Phone:920-264-2065
Mailing Address - Fax:
Practice Address - Street 1:675 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6332
Practice Address - Country:US
Practice Address - Phone:920-264-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer