Provider Demographics
NPI:1881159200
Name:BLANCO, FRANCISCO (LMT)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:FRANCISCO
Other - Middle Name:
Other - Last Name:ZAMORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0006
Mailing Address - Country:US
Mailing Address - Phone:509-682-4713
Mailing Address - Fax:509-682-3218
Practice Address - Street 1:130 E CHELAN AVENEU
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-2888
Practice Address - Country:US
Practice Address - Phone:509-682-4078
Practice Address - Fax:509-682-4079
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60774891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60774891OtherSTATE LICENSE NUMBER