Samuel Blanco

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

50357 Issued in CA

Practice address

215 N State College Blvd Ste G
Anaheim, CA 92806-2932

Phone

(714) 999-6596

NPI assigned

Oct 28, 2019

Last updated

Oct 28, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• State College Physical Therapy

  • Physical Therapist
  • Anaheim, CA
  • NPI 1699780353
  NPD (past)
• State College Physical Therapy Inc

  dba Anaheim Hills Physical Therapy & Rehabilitation

  • Physical Therapist
  • Anaheim, CA
  • NPI 1689782310
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1487297925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 W BLUEBELL AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928024810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N STATE COLLEGE BLVD STE G",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062932",
            "telephone_number": "714-999-6596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCO",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-28",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "50357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Michelle Blanchard
• Martin M Blanco-Eccleston, M.D.
• April Blanco
• Brian Paul Blanco, PT, DPT
• Diana Blanco
• Natalie Bland, NP
• Mosi Jamila Blane
• Richard Hedke Blanks, M.D
• Blast Pharma Inc (Blast Pharmacy)
• Theodore Blatt, MD

• Physical Therapy Assistant in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.