Provider Demographics
NPI:1699024927
Name:BLANTHORN, STEVEN MORRIS (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MORRIS
Last Name:BLANTHORN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N WYMOUNT TERRACE DR
Mailing Address - Street 2:BYU STUDENT HEALTH CENTER
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-8600
Mailing Address - Country:US
Mailing Address - Phone:801-422-9735
Mailing Address - Fax:
Practice Address - Street 1:1750 N WYMOUNT TERRACE DR
Practice Address - Street 2:BYU STUDENT HEALTH CENTER
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-8600
Practice Address - Country:US
Practice Address - Phone:801-422-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267130-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist