Individual
MRS. LAURA BLASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
5273 BROADVIEW RD, PARMA, OH 44134-1626
(216) 749-6650
Mailing address
8732 ROYALHAVEN DR, NORTH ROYALTON, OH 44133-1657
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-11086
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217473
ANTHEMBLUECROSS/BLUESHIEL
OH
05
—
0842995
—
OH
01
—
34-1627933
TRICARE
OH
01
—
OH4655A
BEECH STREET CORPORATION
OH
Enumeration date
09/26/2006
Last updated
07/09/2008
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