Provider Demographics
NPI:1689438442
Name:BLANDINO, SARA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:BLANDINO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17040 W GREENFIELD AVE #6
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6844
Mailing Address - Country:US
Mailing Address - Phone:262-439-8019
Mailing Address - Fax:262-289-9310
Practice Address - Street 1:17040 W GREENFIELD AVE #6
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6844
Practice Address - Country:US
Practice Address - Phone:262-439-8019
Practice Address - Fax:262-289-9310
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10737-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist