Provider Demographics
NPI:1417905084
Name:BLANDA, CRAIG (MPT, CERTMDT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:BLANDA
Suffix:
Gender:M
Credentials:MPT, CERTMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BECKETT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1732
Mailing Address - Country:US
Mailing Address - Phone:856-467-3421
Mailing Address - Fax:856-467-5731
Practice Address - Street 1:520 BECKETT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOGAN TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1732
Practice Address - Country:US
Practice Address - Phone:856-467-3421
Practice Address - Fax:856-467-5731
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA08484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist