Provider Demographics
NPI:1649052242
Name:BLANCHARD, TERA C (LMT)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:C
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MARCUS ST
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:MI
Mailing Address - Zip Code:49288-9701
Mailing Address - Country:US
Mailing Address - Phone:517-262-5581
Mailing Address - Fax:
Practice Address - Street 1:225 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1539
Practice Address - Country:US
Practice Address - Phone:517-264-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist