Regina A. Blanke
Individual provider Active NPI Physical Therapist · Edgewater, FL
NPI 1740891753 · NPPES record last updated Aug 12, 2020
Key facts
- NPI
- 1740891753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 35824 (FL)
- Practice address
- 2010 S Ridgewood Ave
Edgewater, FL 32141-4253 - Phone
- (386) 671-2626
- NPI assigned
- Aug 12, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201006002169 | FL | Practitioner - Physical Therapist in Private Practice | 6800215179 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35824 | FL | MD | Physical Therapist |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florehab Center LLC | Physical Therapist | Current |
Accepting new patients |
Locations
739 S Nova Rd
Ste 739741
Ormond Beach, FL 32174
Phone (386) 671-2626
739 S Nova Rd
#A
Ormond Beach, FL 32174
Phone (386) 589-4366
1402 Dunlawton Ave
Ste 4D
Port Orange, FL 32127
Phone (386) 671-2626
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 35824 | FL | Yes |
Addresses
Primary practice location
2010 S Ridgewood Ave
Edgewater, FL 32141-4253
Mailing address
108 Lincoln Ave
New Smyrna, FL 32169-2534
Phone (850) 499-3796
Other providers in Edgewater, FL
- Samantha Bergoine
- Jeffrey R Berner
- Leslie R Betts
- Bhi of Central Florida Corporation
- Noah Benjamin Bigman
- Todd Vincent Boicourt
- Brilliance Living Corporation
- Joshua Budvarson
- Anne Butler
- Rene Callanta
All providers in Edgewater, FL · Physical Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.