Provider Demographics
NPI:1295236834
Name:BLONIARZ, JOHN PATRICK JR (PTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:BLONIARZ
Suffix:JR
Gender:M
Credentials:PTA
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Mailing Address - Street 1:1395 PARKER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOWN OF TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1395 PARKER BLVD
Practice Address - Street 2:
Practice Address - City:TOWN OF TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-1618
Practice Address - Country:US
Practice Address - Phone:716-837-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011404225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant