Provider Demographics
NPI:1942323761
Name:LAM-BLANCO, PRISCILLA S (MPT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:S
Last Name:LAM-BLANCO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:S
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:9269 HERBON WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7108
Mailing Address - Country:US
Mailing Address - Phone:916-424-4765
Mailing Address - Fax:
Practice Address - Street 1:7230 S LAND PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3657
Practice Address - Country:US
Practice Address - Phone:916-393-0497
Practice Address - Fax:916-393-5567
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist