Provider Demographics
NPI:1114728441
Name:BLANCA, ALEC MITCHEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEC MITCHEL
Middle Name:
Last Name:BLANCA
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DELLCREST DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2804
Mailing Address - Country:US
Mailing Address - Phone:443-540-6498
Mailing Address - Fax:
Practice Address - Street 1:1220A E JOPPA RD STE 109
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5816
Practice Address - Country:US
Practice Address - Phone:410-415-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist