Provider Demographics
NPI:1588371686
Name:BLANCO, BETTY (DT)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 55TH WAY N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-3341
Mailing Address - Country:US
Mailing Address - Phone:727-623-7531
Mailing Address - Fax:
Practice Address - Street 1:9801 55TH WAY N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-3341
Practice Address - Country:US
Practice Address - Phone:727-623-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist