Basic Information
| Provider Information | |||||||||
| NPI: | 1689998288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANKERTZ | ||||||||
| FirstName: | ANNMARIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.P.T. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BLANKERTZ | ||||||||
| OtherFirstName: | ANNMARIE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherCredential: | D.P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6012 LINDEN RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | SWARTZ CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484738889 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6012 LINDEN RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | SWARTZ CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106558244 | ||||||||
| FaxNumber: | 8106552192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2010 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501015563 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.