Individual
MRS. AMY JO BLANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1440 W WALNUT ST, BUILDING #2, JACKSONVILLE, IL 62650-1143
(217) 245-1455
(217) 243-6903
Mailing address
1440 W WALNUT ST, BUILDING #2, JACKSONVILLE, IL 62650-1143
(217) 245-1455
(217) 243-6903
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070009519
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141-989
HEALTHLINK
IL
01
—
216653
GROUP PTAN
IL
01
—
5415281
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/03/2006
Last updated
04/11/2011
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