Provider Demographics
NPI:1902138662
Name:BLANCHFLOWER, NICOLE (MA, ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BLANCHFLOWER
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5966 RANCHO MISSION RD
Mailing Address - Street 2:229
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2586
Mailing Address - Country:US
Mailing Address - Phone:619-840-6824
Mailing Address - Fax:
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:SAN DIEGO STATE UNIVERSITY-DEPT OF ATHLETICS
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-0001
Practice Address - Country:US
Practice Address - Phone:619-594-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist