Provider Demographics
NPI:1720559099
Name:BLONDIN, EMILY RACHEL PARKER (PT, DPT, MSPT)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:RACHEL PARKER
Last Name:BLONDIN
Suffix:
Gender:F
Credentials:PT, DPT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 BLUEBILL LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1341
Mailing Address - Country:US
Mailing Address - Phone:703-338-8175
Mailing Address - Fax:
Practice Address - Street 1:6510 BLUEBILL LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1341
Practice Address - Country:US
Practice Address - Phone:703-338-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225100000XMedicaid