Individual
MARK A BLANKESPOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
308 SE 9TH ST, PELLA, IA 50219-2296
(641) 621-0230
(641) 621-0319
Mailing address
1316 N PRAIRIE ST, PELLA, IA 50219-1383
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02150
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0423822
—
IA
01
—
06121
WELLMARK
IA
Enumeration date
10/18/2006
Last updated
07/08/2007
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