Provider Demographics
NPI:1346702339
Name:BLANKS, ANNEMARIE ELAINE (PT)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:ELAINE
Last Name:BLANKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:419-479-5593
Practice Address - Street 1:7640 SYLVANIA AVE STE O
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9263
Practice Address - Country:US
Practice Address - Phone:419-517-1040
Practice Address - Fax:419-517-1080
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0366133Medicaid