Individual
BLIA COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1675 SHAFFER RD, ATWATER, CA 95301-4456
(209) 357-5121
Mailing address
3212 TUPELO DR, MERCED, CA 95348-9351
(209) 357-5121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 37804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT37804
PT
CA
Enumeration date
09/07/2011
Last updated
09/07/2011
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