Provider Demographics
NPI:1053593392
Name:BLANCH, AMY L (PT, MSPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BLANCH
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5999 HARPERS FARM RD
Mailing Address - Street 2:SUITE E260
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3013
Mailing Address - Country:US
Mailing Address - Phone:410-884-2893
Mailing Address - Fax:410-884-2895
Practice Address - Street 1:5999 HARPERS FARM RD
Practice Address - Street 2:SUITE E260
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3013
Practice Address - Country:US
Practice Address - Phone:410-884-2893
Practice Address - Fax:410-884-2895
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist