Active NPI
Blain Alan Packard
- Physical Therapy Assistant
- Florence, AZ
National Provider Identifier
1639930191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 10016A
- Practice address
- 120 W Highway 287 Ste 2
Florence, AZ 85132-8170 - Phone
- (480) 684-4728
- NPI assigned
- Jan 22, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 10016A | AZ | Primary |
Addresses
Primary practice location
120 W Highway 287 Ste 2
Florence, AZ 85132-8170
Mailing address
23296 N High Dunes Dr
Florence, AZ 85132-7925
Phone (480) 684-4728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10016A | AZ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1639930191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23296 N HIGH DUNES DR",
"city": "FLORENCE",
"state": "AZ",
"postal_code": "851327925",
"telephone_number": "480-684-4728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 W HIGHWAY 287 STE 2",
"city": "FLORENCE",
"state": "AZ",
"postal_code": "851328170",
"telephone_number": "480-684-4728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKARD",
"first_name": "BLAIN",
"middle_name": "ALAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-22",
"last_updated": "2024-01-22",
"certification_date": "2024-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AZ",
"license": "10016A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florence, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.