Provider Demographics
NPI:1952419756
Name:BLANKFIELD, JOHN DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:BLANKFIELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 OSO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-9404
Mailing Address - Country:US
Mailing Address - Phone:505-240-0315
Mailing Address - Fax:505-783-4479
Practice Address - Street 1:582 OSO RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-9404
Practice Address - Country:US
Practice Address - Phone:505-240-0315
Practice Address - Fax:505-783-4479
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist