Provider Demographics
NPI:1447149166
Name:BLANTON, JOSEPH RYAN (PTA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:BLANTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 LIBERIA RD
Mailing Address - Street 2:
Mailing Address - City:WADMALAW ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29487-7200
Mailing Address - Country:US
Mailing Address - Phone:843-271-1319
Mailing Address - Fax:
Practice Address - Street 1:2387 WARM HEARTH DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6281
Practice Address - Country:US
Practice Address - Phone:540-552-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3550225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty