Provider Demographics
NPI:1841516135
Name:BLANKENSHIP-PALACIOS, PAMELA DEE (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DEE
Last Name:BLANKENSHIP-PALACIOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:B.-PALACIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1716 PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2197
Mailing Address - Country:US
Mailing Address - Phone:956-584-5837
Mailing Address - Fax:
Practice Address - Street 1:3601 BUDDY OWENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6447
Practice Address - Country:US
Practice Address - Phone:956-631-6200
Practice Address - Fax:956-631-6433
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist