Provider Demographics
NPI:1851312615
Name:BLANC, ROBERT O (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:O
Last Name:BLANC
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 VALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-3535
Mailing Address - Country:US
Mailing Address - Phone:412-648-8705
Mailing Address - Fax:412-383-8764
Practice Address - Street 1:3450 S WATER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2349
Practice Address - Country:US
Practice Address - Phone:412-648-8705
Practice Address - Fax:412-383-8764
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000081A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer