Individual
TIMOTHY BLANCKAERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9050 E BROWN RD, MESA, AZ 85207-4356
(480) 586-3373
Mailing address
952 S ADAM WAY, GILBERT, AZ 85296-1487
(920) 979-4530
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10147
AZ
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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