Provider Demographics
NPI:1508222340
Name:BLANFORD PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:BLANFORD PEDIATRIC THERAPY LLC
Other - Org Name:PARTNERS IN PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BLANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:859-797-8223
Mailing Address - Street 1:704 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2025
Mailing Address - Country:US
Mailing Address - Phone:859-797-8223
Mailing Address - Fax:
Practice Address - Street 1:704 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2025
Practice Address - Country:US
Practice Address - Phone:502-331-5478
Practice Address - Fax:502-348-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-09
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
KY135224225XP0200X
KY140780235Z00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100415400Medicaid
KY50115322OtherPASSPORT HEALTH
KY7100424590Medicaid
KY7100387750Medicaid