Individual
BRADFORD JON BLANCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT MHA
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT796
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022643
BCBS
—
05
—
246550099
—
ME
01
—
AA32558
HARVARD PILGRIM
—
Enumeration date
12/04/2006
Last updated
07/08/2007
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