Individual
MS. MARY JANE BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
18 SPRUCE STREET, YORK, SC 29745-0770
(803) 684-1905
(803) 684-1907
Mailing address
PO BOX 770, 1475 EAST LIBERTY STREET, YORK, SC 29745-0770
(803) 684-9916
(803) 684-1903
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
91
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91
BOARD OF PHYSICAL THERAPY
SC
Enumeration date
08/21/2013
Last updated
08/21/2013
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