Provider Demographics
NPI:1659264521
Name:BLANCO, CAROLYN MICHELLE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MICHELLE
Last Name:BLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 WYNDBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1713
Mailing Address - Country:US
Mailing Address - Phone:813-598-6210
Mailing Address - Fax:
Practice Address - Street 1:6417 E COUNTY LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1855
Practice Address - Country:US
Practice Address - Phone:813-461-8840
Practice Address - Fax:813-461-8834
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist