Provider Demographics
NPI:1689998288
Name:BLANKERTZ, ANNMARIE ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:ELIZABETH
Last Name:BLANKERTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNMARIE
Other - Middle Name:ELIZABETH
Other - Last Name:BLANKERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6012 LINDEN RD STE 15
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-8889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6012 LINDEN RD STE 15
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473
Practice Address - Country:US
Practice Address - Phone:810-655-8244
Practice Address - Fax:810-655-2192
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist